THE
SPINE
LUMBAR
SPINE
SPINAL
CORD
AND
NERVES
DERMATOMES
CROSS SECTION VIEW
NORMAL
CORTICO-SPINAL TRACTS
ARM AND LEG FIBERS
IMPORTANT ROOT LESIONS
C6 root - biceps absent
wasting thenar muscles
C7 root – wasting small muscle of hand
absent triceps jerk
C8 root- wasting hypothenar muscles
wasting small muscles of hand
C4-C5 – absent pectoral jerk
IMPORTANT ROOT LESIONS
S1 root- hypoasthesia lat side of foot
absent ankle jerk
wasting calf muscles
L5 root – hypoasthesia lat side
great toe
weakness in EHL + TA
L4 root - wasting quadriceps
absent knee jerk
LEVEL OF SPINAL CORD
INJURY
Neurological level
Sensory level
Skeletal level
Zone of partial preservation
NEUROLOGICAL LEVEL
Most caudal segment of spinal cord
with normal motor and sensory
functions on both sides.
Normal segment may differ on two
sides and may differ in motor and
sensory function
NEUROLOGICAL LEVEL
4 different segment
R & L sensory levels
R & L motor levels
SENSORY & MOTOR LEVELS
Most caudal segment with
normal sensory and motor
segment respectively on both
sides
NEUROLOGICAL EXAMINATION
Sensory – 28 dermatomes in each side
Motor - key muscle in each of 10
dermatomes on each side
TYPICAL MUSCLES TESTED
1. Elbow flexion
2. Elbow extension
3. Wrest extension
4. Finger flexion (distal phalanx of middle finger)
5. Finger abduction-little finger
6. Hip flexion
7. Knee extension
8. Ankle dorsiflexion
9. Ankle plantar flexion
10. Long toe extension.
ZONE OF PARTIAL
PRESERVATION
Dermatomes caudal to neurological level
with partial function in complete injuries
THE SKELETAL LEVEL
Level of greatest vertebral damage on
radiological examination
Skeletal levels and neurological levels may be
similar or differ by one or two segments.
IMP. DERMATOME LEVELS
C5- Clavicle
C6,7,8 – Hand
T4 – Nipples
T10 – Umbilicus
T12 - Groin
S2 S3 S4 – Perineum
S5 – Anus
S2 S3- Genitalia.
MRC Classification
1943
Essentially motor
¾ Total paralysis ……...0
¾ Visible contraction ……...1
¾ Movement without gravity ……...2
¾ Movement with gravity ……...3
¾ Movement against some
resistence ……...4
¾ Normal… …..….5
FRANKEL’S
CLASSIFICATION
A. Complete loss both motor and sensory
function
B. Complete motor loss, preservation of
some sensations
C. Motor function preserved but useless
D. Motor function useful but weak
E. Neurologically intact.
ASIA / IMSOP
CLASSFICATION
¾ ASIA = American Spinal Injury Association
1991
¾ IMSOP = International Medical Society of
Paraplegia 1992
¾ NASCIS = North American Spinal Cord Injury
Study
INTERNATIONAL STANDARDS
CLASSIFICATIONS
Grade A – complete : no motor and sensory
function. no function in S4 and S5.
Grade B – incomplete : no motor. some
sensations preserved. sensations
preserved in S4 and S5.
Grade C – incomplete : muscle power less
than 3 .
INTERNATIONAL STANDARDS
CLASSIFICATIONS
Grade D – incomplete : muscle power 3 or
more.
Grade E - normal : motor and sensory
functions.
IMMEDIATE ASSESSMENT
NASCIS
Motor = 0 to 5.
No, Flicker, mov. without gravity, mov.
with gravity, mov. against resistance,
normal.
14 muscle groups on each side
Score 0 to 70 points on each side.
ASSESSMENT SENSORY
NASCIS
Pinprick and light touch
29 segments on each sides
¾ No sensation ….. 1
¾ Hypoasthesia …. 2
¾ Normal ……… 3
Score varies from 29 to 87.
Deep pain on 6 parts: thumb, little finger and
wrist with toe, ankle and knee.
Absent = 1: Diminished = 2: Normal = 3
ADL
Self care
Sph. control
Mobility
Locomotion
FIM: 6 CATEGORIES
Self care
Sph. control
Mobility
Locomotion
Communication
Social integration
NASCIS ASSESSMENT
Immediately on admission
Assessment at one year (includes FIM)
