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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 10, 2016
Footnotes
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant nos. 90SI5011, 90SI5003, H133N110006). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this report do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
