MRCP Anatomy: Spinal Cord Tracts (MRCP Part 1)

TL;DR

For MRCP Part 1, spinal cord tract questions are about localisation, not drawing diagrams. If you understand what each tract carries, where it crosses, and the clinical deficit it produces, you can solve most questions in seconds. This article distils the examinable scope, high-yield tracts, classic traps, and a short MRCP-style case.

Why spinal cord tracts matter in MRCP Part 1

Spinal cord anatomy is one of the most predictable yet commonly misunderstood areas tested in MRCP Part 1. The exam does not reward memorising labelled cross-sections; instead, it repeatedly tests your ability to translate a short clinical vignette into an anatomical localisation.

A typical question might describe asymmetric weakness, selective sensory loss, or bladder involvement and ask where the lesion lies. If you can mentally map symptoms to tracts, you gain a reliable scoring area that links anatomy, neurology, and physiology.

This post supports the main MRCP Part 1 overview and is designed to be used alongside question practice from the Crack Medicine QBank.

Examinable scope: what MRCP actually expects

MRCP Part 1 focuses on core long tracts, not obscure pathways. You should be comfortable with:

• Function of each major tract

• Level and pattern of decussation

• Ipsilateral vs contralateral deficits

• Classical cord syndromes

You are not expected to memorise segmental lamination or rare named tracts.

The 5 most tested spinal cord tracts

1. Corticospinal tract

Function: Voluntary motor controlCrossing: Pyramidal decussation in the caudal medulla

• Lesion above decussation → contralateral UMN weakness

• Lesion below decussation (spinal cord) → ipsilateral UMN signs below lesion

• Early spinal cord injury may cause temporary flaccidity (spinal shock)

Exam pearl: Increased tone, brisk reflexes, and extensor plantar response point to corticospinal involvement.

2. Dorsal columns (posterior columns)

Function: Vibration, proprioception, fine touchComponents:

• Fasciculus gracilis (lower limb, medial)

• Fasciculus cuneatus (upper limb, lateral)

Crossing: Medulla (internal arcuate fibres)

• Spinal cord lesion → ipsilateral loss below the level

• Sensory ataxia and positive Romberg sign are key clues

3. Spinothalamic tract

Function: Pain and temperatureCrossing: 1–2 spinal segments above entry via anterior white commissure

• Cord lesion → contralateral loss beginning a few levels below

• Central cord lesions affect this tract early

Classic trap: Pain loss does not start exactly at the level of the lesion.

4. Spinocerebellar tracts

Function: Unconscious proprioception and coordinationCrossing: Mostly uncrossed (or double-crossed)

• Lesions cause ipsilateral limb ataxia

• Tested infrequently and usually as part of broader cord pathology

5. Autonomic pathways

Function: Sympathetic and parasympathetic control

• Lesions above T6 → risk of autonomic dysreflexia

• Sacral cord involvement → bladder, bowel, sexual dysfunction

• Often used to help localise level, not as isolated questions

High-yield summary table

Tract	Modality	Crossing point	Deficit in spinal cord lesion
Corticospinal	Motor	Medulla	Ipsilateral UMN signs below
Dorsal columns	Vibration, proprioception	Medulla	Ipsilateral loss below
Spinothalamic	Pain, temperature	1–2 levels above entry	Contralateral loss below
Spinocerebellar	Coordination	Mostly uncrossed	Ipsilateral ataxia

Core syndromes examiners love

Brown-Séquard syndrome (hemisection)

This is one of the highest-yield applications of spinal tract anatomy in MRCP Part 1.

• Ipsilateral:

  • UMN weakness (corticospinal)

  • Loss of vibration and proprioception (dorsal columns)

• Contralateral:

  • Loss of pain and temperature starting a few levels below

Typical stem: Penetrating trauma, unilateral compression, tumour.

Central cord syndrome / syringomyelia

• Early bilateral loss of pain and temperature in a “cape-like” distribution

• Dorsal columns initially spared

• Due to damage at the anterior white commissure

Mini-case (MRCP-style question)

Question A 29-year-old man presents after a stab injury to the right side of his thoracic spine. Examination shows right-sided spastic weakness below T9, loss of vibration sense on the right below T9, and loss of pain sensation on the left starting from T11 downwards. Where is the lesion?

Answer Right-sided hemisection of the spinal cord at T9.

Explanation

• Ipsilateral UMN signs → corticospinal tract below decussation

• Ipsilateral vibration loss → dorsal column involvement

• Contralateral pain loss beginning below the lesion → spinothalamic crossing pattern

This is a classic MRCP Part 1 localisation question.

10 high-yield points to remember

1. Spinal cord lesions cause ipsilateral UMN signs below the lesion.

2. Pain and temperature cross early in the spinal cord.

3. Vibration and proprioception cross in the medulla.

4. Spinothalamic loss starts a few segments below the lesion.

5. Brown-Séquard = ipsilateral motor + contralateral pain loss.

6. Central cord lesions affect pain and temperature first.

7. Posterior column damage causes sensory ataxia.

8. Autonomic symptoms help identify lesion level.

9. Think in patterns, not isolated deficits.

10. Always ask: Which side? Which modality? Where does it cross?

Common mistakes (and how to avoid them)

• Mixing up UMN and LMN signs → always check reflexes and tone

• Assuming all tracts cross at the same level

• Forgetting delayed spinothalamic crossing

• Over-focusing on rare tracts instead of core pathways

• Ignoring bladder or autonomic clues

Practical study checklist

• Revise tracts alongside clinical deficits, not diagrams alone

• Link each tract to one classic syndrome

• Practise localisation questions using the Crack Medicine QBank

• Review explanations carefully, not just scores

• Test readiness with full papers from Crack Medicine Mock Tests

FAQs

Which spinal cord tracts are most important for MRCP Part 1?

Corticospinal, dorsal column, and spinothalamic tracts account for the majority of questions.

Do I need to memorise spinal cord cross-sections?

No. Understanding function, crossing, and clinical patterns is sufficient.

Is Brown-Séquard syndrome commonly tested?

Yes. It is one of the most reliable ways examiners assess tract anatomy.

How is pain and temperature loss typically tested?

As contralateral loss beginning a few segments below the lesion.

Ready to start?

Spinal cord tracts are a high-yield, low-risk area for MRCP Part 1 if approached clinically. Focus on localisation, practise pattern recognition, and integrate anatomy with short vignettes.

Start with the MRCP Part 1 hub, reinforce learning using the QBank, and benchmark your progress with Mock Tests.

Sources

• MRCP(UK) Examination Syllabushttps://www.mrcpuk.org/mrcpuk-examinations/part-1

• Blumenfeld H. Neuroanatomy Through Clinical Cases. Oxford University Press

• Snell RS. Clinical Neuroanatomy. Wolters Kluwer