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mcl
Yeah, I just stared at this again for a solid 5 minutes straight up dying. I think if we're going with the L/R labels as they are shown on the image, imagine the patient lying on their stomach with their feet pointed towards you and it should make sense.
+10
ankigravity
But why would anyone ever view a patient like that? I mean, in the era of Covid and proning, maybe.
+
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chris07
I think the assumption here is that we are dealing with the cord section at the level of the problem. The picture is incredibly misleading. You have to orient yourself. The dorsal columns F, E, A, B are facing the patient's posterior. Once you properly orient it in 3D space, you know that what's labeled "right" is actually the patient's left, and what's labeled "left" is his right side. Super confusing.
+2
sne
The input arises in a limb/part of body at the level of lesion, enters through the dorsal root (pictured between A and B), decussates and ascends at the anterior commissure, and finally synapses on the second order neuron in the lateral spinothalamic tract. So the spinothalamic tract is responsible for contralateral pain and temperature sensation. So AT THE LEVEL technically would be in the dorsal column
+13
nwinkelmann
also, @chris07, I think you're wrong about the labels being wrong on the image. Becuase the spinothalamic tract = contralateral pain and temperature, and the patient's pain is on the right side, you would want to target the left spinothalamic tract for pain relief, i.e. the area labeled H. The area labeled D would be the right spinothalamic, purely because that is how the image is labeled. If you assume the label is different, you will get it wrong.
+12
kpjk
@sne I don't think entering from the dorsal root would be between A and B. It would be part of the gray matter so, lateral to B and F
+3
ih8payingfordis
I think the key thing here is to recognize that the cross section we're looking at is a CERVICAL section, which means it's definitely higher than the source of pain (back and abdomen). That tells you that the tract must have crossed already so you target the contralateral side.
Here is a good link to identify where the cord is from (cervical, thoracic, lumbar and sacral): https://nba.uth.tmc.edu/neuroanatomy/imgsSwfs/L04P08F1.png
+4
If you assume that because the pt has R-sided back and ab pain somewhere in the lower thoracic, and you know that this slice of cord is above that because it has a posterior intermediate sulcus present (i.e. has both a gracilus and cuneatus track), then you know that the spinal cord slice is likely above where the pain is, therefore the spinothalamic has crossed over already.
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submitted by โsympathetikey(1600)
Pain & temperature fibers for the right side come in on the dorsal right side, cross at the anterior white commisure, and travel up in the Spinothalamic tract.
https://lh3.googleusercontent.com/-B4YXuXT68ts/V2Wu-kGlZyI/AAAAAAAAljk/3j2iHrI9hQ4/s640/blogger-image--1680479964.jpg