Impotence and ejaculatory impairment or difficulty attaining orgasm are frequent complaints if asked for. Damage to anterior root or anterior horn cell produces atrophy, flaccid weakness and fasciculations in a myotomal distribution. Damage to dorsal root or dorsal root entry zone produces sensory loss in a dermatomal distribution. Damage to either motor or sensory pathways will give reflex loss. Note that patients may complain of this themselves, particularly after putting their foot hard on the brake-pedal of a car.
Typical sign is one of a sensory level below which sensation is diminished.
Since diaphragm is supplied by C345, confusion of a C4 level with a T3 level can be a life-threatening error. Note that touch and pain are often not entirely lost in cord lesions because they are carried in bilateral and diffuse ascending systems. Typically there is development of an upper motor neuron bladder with signs of urgency, urge incontinence and a small volume bladder. There may also be faecal incontinence and alterations of sweating and blood pressure. Commonest are C56 and C67 discs, which compress the sixth and seventh cervical roots respectively.