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Neurosurgery Resource > Spine > Flashcards

Spine Flashcards

1
Q

The spinal cord extends from which structure?

A

Medulla

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2
Q

At what level does the spinal cord terminate?

A

L1/L2

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3
Q

What information is received by the dorsal horns of grey matter?

A

Somatosensory

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4
Q

What is contained within the ventral horns of grey matter?

A

Motor neurones

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5
Q

At what levels is the lateral horn of grey matter found?

A

T1-L2

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6
Q

What is contained within the lateral horn of grey matter?

A

Autonomic neurones

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7
Q

What are the main ascending tracts of the spinal cord?

A

Dorsal column medial lemniscus (DCML)

Spinothalamic

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8
Q

What sensory modalities are carried within the DCML pathway?

A

Fine touch
Pressure
Vibration

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9
Q

DCML fibres from below T6 travel up the spinal cord in what?

A

Fasciculus gracilis

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10
Q

DCML fibres from T6 and above travel up the spinal cord in what?

A

Fasciculus cuneatus

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11
Q

Where do first order DCML fibres synapse?

A

Medulla

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12
Q

The DCML fibres decussate to which structures?

A

Contralateral medial lemniscus

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13
Q

After decussating to the contralateral medial lemniscus, what happens?

A

The fibres synapse in the thalamus before signal is relayed to the somatosensory cortex

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14
Q

What sensory modalities are carried within the spinothalamic tract?

A

Pain

Temperature

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15
Q

Where do the first order neurones of the spinothalamic tract synapse?

A

Dorsal horn

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16
Q

The spinothalamic fibres decussate after synapsing in the dorsal horn. True/false?

A

True

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17
Q

Where do the second order neurones of the spinothalamic tract synapse?

A

Thalamus

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18
Q

What is the function of the spinocerebellar pathways?

A

Provide unconscious proprioceptive information to cerebellum

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19
Q

The dorsal spinocerebellar pathway carries proprioceptive information from where?

A

Muscle spindles of lower limbs

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20
Q

The cuneocerebellar pathway carries proprioceptive information from where?

A

Upper limbs

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21
Q

The ventral spinocerebellar pathway carries proprioceptive information from where?

A

Golgi tendons of lower limbs

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22
Q

The spinocerebellar tracts transmit information to the ipsi-/contra-lateral cerebellum

A

Ipsilateral

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23
Q

What are the main pyramidal tracts?

A

Corticospinal

Corticobulbar

24
Q

The corticospinal tract is responsible for what?

A

Voluntary movements

25
Q

The majority of the corticospinal tract fibres decussate at the medullary pyramids. True/false?

A

True

26
Q

What do decussated corticospinal tract fibres descend within?

A

Lateral corticospinal tract

27
Q

What do undecussated corticospinal tract fibres descend within?

A

Anterior corticospinal tract

28
Q

What is contained with corticobulbar tracts?

A

UMN of cranial nerves

29
Q

Pyramidal tracts originate at the brainstem and extra-pyramidal tracts originate at the motor cortex. True/false?

A

False - pyramidal tracts originate at motor cortex and extra-pyramidal at brainstem

30
Q

What does the vestibulospinal tract control?

A

Balance and posture (innervates anti-gravity muscles)

31
Q

What do the reticulospinal tracts control?

A

Reflex responses

Tone

32
Q

What does the rubrospinal tract do?

A

Excites flexor muscles and inhibits extensor muscles of upper body

33
Q

What does the tecto-spinal tract co-ordinate?

A

Movement of head and neck

34
Q

What are the innervations of the ankle, triceps, biceps and knee reflexes?

A

Biceps - C5/6
Triceps - C7/8
Knee - L3/4
Ankle - S1/2

35
Q

What occurs in disc herniation?

A

The nucleus pulposis herniates through a tear in the annulus ring

36
Q

A paramedian herniated disc typically compresses the transversing/exiting nerve

A

Transversing (the nerve root that exits below the level or prolapse)

37
Q

A lateral herniation at L4/L5 will damage which nerve?

A

L4

38
Q

What is radiculopathy?

A

Dysfunction of a nerve root causing dermatomal sensory deficit

39
Q

Give some clinical features of cauda equina syndrome

A

Painless urinary retention
Saddle paraesthesia
Incontinence
Lower back pain

40
Q

What is treatment for cauda equina syndrome?

A

Surgical decompression

41
Q

What is spinal stenosis?

A

A narrowing of the spinal cord leading to neurogenic claudication

42
Q

Give some clinical features of spinal stenosis

A

Hip/buttock/lower extremity pain
Burning sensation
Relieved by walking uphill

43
Q

How is spinal stenosis treated?

A

Conservatively (physio and analgesia)

Lumbar laminectomy

44
Q

What occurs in cervical spondylosis?

A

Degenerative arthritic process of the cervical spine

45
Q

How can patients with cervical spondylosis present?

A

Degenerative cervical myelopathy (UMN signs)

Radiculopathy (LMN signs)

46
Q

How is cervical spondylosis treated?

A

Surgery (laminectomy/disectomy)

47
Q

What are some clinical features of degenerative cervical myelopathy?

A

Imbalance of gait
Clumsy hands
Pain
Hyperreflexia

48
Q

What investigation is the gold standard for cervical myelopathy?

A

MRI

49
Q

What occurs in anterior cord syndrome?

A

There is cord infarction in the area supplied by the anterior spinal artery

50
Q

What sensations are lost in anterior cord syndrome?

A

Pain and temperature below level of injury

51
Q

How do patients with cord transection present initially?

A

Flaccid arreflexic paralysis

52
Q

What sensation is lost ipsilaterally in Brown-Sequard syndrome?

A

Proprioception

53
Q

What sensations are lost contralaterally in Brown-Sequard syndrome?

A

Pain and temperature

54
Q

What is the cause of central cord syndrome?

A

Acute extension injury to already stenotic neck

55
Q

Give some clinical features of central cord syndrome

A

Bilateral upper limb weakness

“Cape-like” spinothalamic sensory loss

Neurosurgery Resource (5 decks)

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