International Standards for the Classification of Spinal Cord Injury Key Sensory Points (June 2008)

International Standards for the Classification of Spinal Cord Injury: Overview

• Standard Reference: This document details the International Standards for the Classification of Spinal Cord Injury (ISNCSCI) Key Sensory Points.
• Document Version: June 2008.
• Core Purpose: To provide exact anatomical landmarks (key sensory points) for each spinal cord dermatome level, ensuring consistency in clinical assessment.

Cervical Spinal Levels (C2 - C8)

• C2: Located at least $1\,\text{cm}$ lateral to the occipital protuberance at the base of the skull. Alternatively, this point can be located at least $3\,\text{cm}$ behind the ear.
• C3: Located within the supraclavicular fossa, specifically at the midclavicular line.
• C4: Located directly over the acromioclavicular joint.
• C5: Located on the lateral (radial) side of the antecubital fossa, situated just proximal to the elbow.
• C6: Located on the dorsal surface of the proximal phalanx of the thumb.
• C7: Located on the dorsal surface of the proximal phalanx of the middle finger.
• C8: Located on the dorsal surface of the proximal phalanx of the little finger.

Thoracic Spinal Levels (T1 - T12)

• T1: Located on the medial (ulnar) side of the antecubital fossa, situated just proximal to the medial epicondyle of the humerus.
• T2: Located at the apex of the axilla.
• T3: Located at the midclavicular line and the third intercostal space. This space is identified by palpating the anterior chest to locate the third rib; the key sensory point is in the corresponding intercostal space immediately below that rib.
• T4: Located at the midclavicular line and the fourth intercostal space, which is at the level of the nipples.
• T5: Located at the midclavicular line and the fifth intercostal space. This point is positioned midway between the level of the nipples (T4) and the level of the xiphisternum (T6).
• T6: Located at the midclavicular line, at the level of the xiphisternum.
• T7: Located at the midclavicular line, at a distance exactly one quarter ($\frac{1}{4}$) the way between the level of the xiphisternum (T6) and the level of the umbilicus (T10).
• T8: Located at the midclavicular line, at a distance exactly one half ($\frac{1}{2}$) the way between the level of the xiphisternum (T6) and the level of the umbilicus (T10).
• T9: Located at the midclavicular line, at a distance exactly three quarters ($\frac{3}{4}$) the way between the level of the xiphisternum (T6) and the level of the umbilicus (T10).
• T10: Located at the midclavicular line, at the level of the umbilicus.
• T11: Located at the midclavicular line, positioned midway between the level of the umbilicus (T10) and the inguinal ligament.
• T12: Located at the midclavicular line, directly over the midpoint of the inguinal ligament.

Lumbar Spinal Levels (L1 - L5)

• L1: Located at the midpoint between the key sensory points defined for T12 and L2.
• L2: Located on the anterior-medial thigh. It is found at the midpoint of an imaginary line connecting the midpoint of the inguinal ligament and the medial femoral condyle.
• L3: Located at the medial femoral condyle, just above the level of the knee.
• L4: Located directly over the medial malleolus.
• L5: Located on the dorsum of the foot at the third metatarsal phalangeal joint.

Sacral Spinal Levels (S1 - S4/5)

• S1: Located on the lateral aspect of the calcaneus (the heel bone).
• S2: Located at the midpoint of the popliteal fossa (the back of the knee).
• S3: Located over the ischial tuberosity or the infragluteal fold.
  • Clinical Caveat: The document notes that depending on the individual patient, their skin can move superiorly, inferiorly, or laterally over the ischii, which may affect the exact positioning of this point.
• S4/5: Located in the perianal area, positioned less than $1\,\text{cm}$ lateral to the mucocutaneous junction.