3.  31 segments
 Embryological developmentgrowth
of cord lags behind  mature spinal
cord ends at L1

5.  Upper  quadriplegia + weakness of
diaphragm
 C4-C5  Quadriplegia
 C5-C6 Biceps

6. C7 extensors
C8 flexion

7.  Nipples T4
 Umbilicus T10
 SENSORY LEVEL
 Disturbance of bladder & bowel habits

8.  L2-L4  Paralysis of flexion & adduction of
thigh + weakening of leg extension at knee+
patellar reflex lost
 L5-S1 Mvmnts of foot & ankle + flexion &
knee + extension of thigh + ankle jerk LOST

9.  B/L saddle anaesthesia [S3-S5]
 Bladder & Bowel dysfunction
 Impotence
 Bulbocavernosus & anal reflexes absent
 Muscle strength preserved

10. Low back& radicular pain
Asymmetrical leg weakness , sensory
loss,areflexia in lower extremities
Sparing of bowel & bladder function

11.  1) Distribution of root pain
ask for specific dermatomes involved
due to the involvement of posterior nerve
roots

28.  2) Upper border of sensory loss
examine the patient from below upwards
for demonstration of upper border of
sensory loss
Due to the affection of spinothalamic tract

29.  3) Girdle like sensation / sense of
constriction at the level of lesion
 due to the involvement of posterior
column

30. 4) Zone of hyperaesthesia/ hyperalgesia
 localise the level of lesion one segment
below
Due to compression of posterior nerve
roots

31.  5) Analysis of abdominal reflex
[ upper abdominal reflex (T7-T9) intact -
loss of middle (T9-T11) & lower (T11-T12)
ones - site of lesion is probably at T10
spinal segment ]

32.  6) Atrophy of the muscles in a segmental
distribution
Due to involvement of anterior horn cells

33.  7) Loss of deep reflexes if the particular
segment is innvolved
 brisk below the involved segment

34.  8) Analysis of BEEVOR’S SIGN
 when the patient attempts to lift his head
up from the pillow, against resistance
 Rectus abdominis
useful in deciding the level of thoracic
spoinal cord lesions

35.  9) Deformity / any swelling in the vertebra

36.  10) Tenderness in the verterbra

37.  11) Area of sweating
 Lack of sweating below the level

38.  12) level can also be localised by X-Ray of
the spine, Myelography, CT Scan / MRI

39. DETERMINATION OF SPINAL SEGMENTS IN
RELATION TO VERTEBRA…

40.  Cervical vertebra
add 1

41.  T1 - T6
Add 2

42.  T7 – T9
Add 3

43.  T 10
overlies L 1 & L 2 segments

44.  T 11
overlies L 3 & L4 Segments

45.  T 12
Arch overlies L 5 segment

46.  L I arch overlies sacral & coccygeal
segments

47.  Inthe case of non-
compressive myelopathy
, the question of localisation
of the level of lesion does not
arise

48. Synopsis Of Bladder Dysfunction In
Neurological Diseases NEUROGENIC
BLADDER
 UB receives nerve supply from
sympathetic- L 1,2,3 [ NERVE OF FILLING ]
& Parasympathetic- S 2,3,4 [NERVE OF
EVACUATION]

50.  A) Incomplete lesion
Precipitancy  involvement of inhibitory
fibres [multiple sclerosis]
Hesitancy  facilitatory fibres involved
[incomplete cord compression]

51.  B) Complete lesion
1-Retention of urine wt overflow incontinence
commonly seen in ‘neural shock stage’
of a/c transverse myelitis
 evacuation of bladder is usually
incomplete

52. 2-Automatic Bladder
evacuation complete
commonly seen when the neuronal shock
stage is over& evacuation occurs by local
reflex arc
 frequency, urgency &urge incontinence

53.  C) Lesion in the local reflex arc
1- sensory paralytic bladder
loss of awareness of fullness of
bladder
 large volume of urine collects in the
bladder wt huge residual volume

54. 2- motor paralytic bladder
 inability to initiate & continue
micturition
 seen in trauma, pelvic neoplasm

55. 3- Autonomous bladder-
 common in cauda equina
lesions, pelvic malignancy, spina bifida
no sensation of bladder fullness, bt
having continuous dribbling