Neurosurgery Module I - Spine

Sensory afferents of the dorsal column pathway, after passing the medulla, decussate to the contralateral [blank_start]medial[blank_end] lemniscus before eventually synapsing in the thalamus.

Which of the following pictures correctly identifies Brown-Séquard syndrome?

Spinocerebellar tracts provide unconscious proprioceptive information to the cerebellum. Do their tracts provide contralateral or ipsilateral information to the cerebellum?

The [blank_start]corticobulbar[blank_end] tracts of the pyramidal system contain the upper motor neurone of the cranial nerves.

Lesions of the facial nerve: [blank_start]Upper motor neuron lesion[blank_end] = Paralysis of lower half of one side of the face only - forehead muscles remain intact [blank_start]Lower motor neuron lesion[blank_end] = Paralysis of one half of the face including forehead muscles

Bell's Palsy is a lesion of the Facial nerve's [blank_start]lower[blank_end] motor neuron

In terms of the extrapyramidal tracts: The Vestibulospinal tract originates from the vestibular nucleus in the [blank_start]pons[blank_end].

The reticulospinal tracts originate from the reticular formation and control tone. [blank_start]Pontine reticulospinal tract[blank_end]: facilitates voluntary/reflex responses and increases tone [blank_start]Medullary reticulospinal tract[blank_end]: inhibits voluntary/reflex responses and decreases tone

The rubrospinal tract is responsible for exciting flexor muscles and inhibiting extensor muscles of the upper body

The tectospinal tract originates from ...

Which is the only vertebrae not to have a spinous process or body? [blank_start]C1[blank_end]

In terms of vertebral anatomy, the ligamentum [blank_start]flavum[blank_end] runs vertically connecting the lamina of adjacent vertebrae. It helps maintain an upright posture and assist straightening the spine after flexion.

A lumbar disc herniation is more likely to occur in [blank_start]young[blank_end] patients, due to a strain on the spine (e.g. lifting heavy load). The most common type of disc herniation is a paramedian herniated disc. If a paramedian herniated disc was to occur at the L3/4 level, which nerve would be affected? (L3 or L4) [blank_start]L4[blank_end]

The sciatic nerve runs from spinal levels L[blank_start]4[blank_end]-S[blank_start]3[blank_end]

Sciatica pain is typically exaggerated by coughing/sneezing

In the case of an L5/S1 prolapsed intervertebral disc where the S1 root is involved, which reflex would you expect to be absent? [blank_start]Ankle Jerk[blank_end] Reflex

Cauda equina syndrome most commonly occurs due to a midline disc herniation at which vertebral level?

A PR exam should be conducted only where necessary in a potential Cauda Equina Syndrome patient, as such an invasive exam may worsen the patient's prognosis.

If symptoms are tolerable and the walking distance is not significantly affected then conservative treatment should be offered before any surgical intervention.

In terms of Cervical Myelopathy, decompressive spinal surgery should only be offered following a trial of analgesia and physiotherapy.

How does Brown-Sequard Syndrome present?