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Patterns of Sacral Sparing Components on Neurologic Recovery in Newly Injured Persons With Traumatic Spinal Cord Injury

Published:March 10, 2016DOI:https://doi.org/10.1016/j.apmr.2016.02.012

      Abstract

      Objective

      To assess the patterns of sacral sparing and recovery in newly injured persons with traumatic spinal cord injury (SCI).

      Design

      Retrospective analysis of data from the national Spinal Cord Injury Model Systems (SCIMS) database for patients enrolled from January 2011 to February 2015.

      Setting

      SCIMS centers.

      Participants

      Individuals (N=1738; age ≥16y) with traumatic SCI admitted to rehabilitation within 30 days after injury with follow-up at discharge, at 1 year, or both.

      Interventions

      Not applicable.

      Main Outcome Measures

      International Standards for Neurological Classification of Spinal Cord Injury examination results at admission and follow-up (discharge or 1y, or both).

      Results

      Conversion from an initial American Spinal Injury Association Impairment Scale (AIS) grade A to incomplete status was 20% at rehabilitation discharge and 27.8% at 1 year, and was greater in cervical and low paraplegia levels (T10 and below) than in high paraplegia level injuries (T1-9). Conversion from AIS B to motor incomplete was 33.9% at discharge and 53.6% at 1 year, and the initial sparing of all sacral sensory components was correlated with the greatest conversion to motor incomplete status at discharge and at 1 year. For patients with initial AIS C, the presence of voluntary anal contraction (VAC) in association with other sacral sparing was most frequently observed to improve to AIS D status at discharge. However, the presence of VAC alone as the initial sacral sparing component had the poorest prognosis for recovery to AIS D status. At follow-up, regaining sacral sparing components correlated with improvement in conversion for patients with initial AIS B and C.

      Conclusions

      The components of initial and follow-up sacral sparing indicated differential patterns of neurologic outcome in persons with traumatic SCI. The more sacral components initially spared, the greater the potential for recovery; and the more sacral components gained, the greater the chance of motor recovery. Consideration of whether VAC should remain a diagnostic criterion sufficient for motor incomplete classification in the absence of other qualifying sublesional motor sparing is recommended.

      Keywords

      List of abbreviations:

      AIS (American Spinal Injury Association Impairment Scale), DAP (deep anal pressure), HP (high paraplegia), LP (low paraplegia), LT (light touch), PP (pinprick), SCI (spinal cord injury), SCIMS (Spinal Cord Injury Model Systems), VAC (voluntary anal contraction)
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