Spine Flashcards
Questions covering required knowledge of spinal anatomy for the primary FRCA exams, particularly relevant for the SOE and OSCE. There is considerable overlap with neurophysiology in past spinal anatomy stations for the OSCE, and this is reflected in these flashcards.
For a lumbar epidural block, what volume of local anaesthetic is required per segment to be blocked?
1.5 - 2.0 ml
What is the total cerebrospinal fluid (CSF) volume in the adult?
100 - 200 ml
What is the normal spinal CSF pressure in the supine patient?
7 - 20 cm H2O (5-15 mm Hg)
In a transverse section of the spinal cord, of what is the grey matter composed?
Nerve cell bodies and unmyelinated axons
What does the dorsal root ganglion contain?
Cell bodies of the afferent neurons
Describe the neurological pathway followed after stimulation of a nociceptor by a painful stimulus from the point of entry into the spinal cord
Enters the spinal cord via the posterior nerve root, synapses in the dorsal horn, crosses the midline to ascend in the lateral spinothalamic tract. After synapsing in the thalamus, impulses are relayed to the sensory cortex
Identify the lateral spinothalamic tract on the diagram

Area marked A
What modality is carried by the anterior spinothalamic tract?
Touch (coarse touch & pressure)
Which spinal tracts are represented by the area marked B?

Spino-cerebellar tracts (anterior and posterior).
These tracts are responsible for proprioceptive signals, obtained from the golgi tendons and muscle spindles.
What does the area marked C on the diagram represent and what modalities are carried by it?

Dorsal/posterior columns.
Proprioception from skin and joints, fine touch, vibration, two-point discrimination
What is the specific gravity of CSF?
1003-1009 (1.003-1.009)
Which spinal tracts are represented by area E

Anterior corticospinal tracts (innervate axial muscles)
Which spinal tract is represented by Area D?

Lateral corticospinal tract (limb muscles)
What type of nerve impulses travel in the corticospinal tracts and how do the fibres terminate?
Descending motor impulses.
They synapse with motor neurones in the anterior horn.
Within the spinal cord, where are ascending pain and temperature fibres carried?
Lateral spinothalamic tract
What vessels contribute to the arterial blood supply of the cord?
Anterior spinal artery
Posterior spinal artery (arises from vertebrals or PICA)
Spinal branches of the vertebral, intercostal, lumbar and sacral arteries
*Great anterior medullary artery (Artery of Adamkiewicz) - this usually arises on the left from a posterior intercostal artery between level T9-12
What is the origin of he anterior spinal artery?
Branch from each of the vertebral arteries
What is the clinical effect of thrombosis of the anterior spinal artery?
Loss of motor and most sensory modalities, with sparing of proprioception, fine touch and vibration (dorsal columns)
What are the extrapyramidal tracts responsible for?
Control of posture and muscle tone
Where are the lateral horns found and what do they contain?
The lateral horns are only found in the thoracic segments of the spinal cord, and they contain the preganglionic sympathetic neurons
What structure attaches the spinal cord to the coccyx, and what is derived from?
The fiulm terminale. This is formed by merged layers of pia and dura mater
What is the conus medullaris?
The tapering caudal end of the spinal cord
What deficiencies result from anterior spinal artery syndrome?
Paraplegia
- α motor neurons in anterior horn damaged (LMN injury)
- descending (UMN) axons in corticospinal tracts disrupted
Sensory Loss
- Loss of coarse touch, pressure (anterior spinothalamic tracts)
- Loss of temperature and pain sensation (lateral spinothalamic tracts)
- n.b. there is sparing of the dorsal columns, so fine touch, proprioception and vibration is usually intact
Autonomic dysfunction
- Disruption of sacral parasympathetic neruons
Where does the spinal cord terminate in adults and in neonates?
L1/2 and L3




