Abstract
Objective
To determine whether the “sacral sparing” definition for completeness of traumatic
spinal cord injury (SCI) is a more stable definition than the previously used Frankel
Classification.
Design
Retrospective analysis of individuals enrolled in the Spinal Cord Injury Model Systems
(SCIMS) database between 2011 and 2018.
Setting
SCIMS centers.
Participants
Individuals (N=804) with traumatic SCI who were at least 16 years old at time of injury,
were admitted to rehabilitation within 30 days, had American Spinal Injury Association
Impairment Scale (AIS) grades A-D at admission, and had complete neurologic data at
the time of admission and 1 year.
Intervention
Not applicable.
Main Outcome Measures
Frankel and AIS scores were computed for a cohort of 804 eligible cases. Stability
was compared between the 2 classification systems by calculating the proportions of
cases in which regression (conversion to a more severe impairment level) was observed.
Results
A larger proportion of individuals classified with “incomplete” injuries (grades B-D)
at the time of admission using the Frankel system regressed to complete status at
1 year compared with the AIS criteria (9.4% vs 2.0%). Those with grade B injuries
regressed to grade A more often using the Frankel system compared with the AIS system
(19.7% to 5.4%). A larger proportion of people diagnosed as Frankel grade C or D regressed
to Frankel grade A compared with individuals diagnosed as AIS grade C or D who regressed
to AIS grade A (5.0% to 1.1%).
Conclusions
More individuals diagnosed with neurologically incomplete SCI regressed to complete
status at 1 year when using the Frankel system compared with AIS classification, which
is based on sacral sparing. This reinforces the finding that the “sacral sparing”
definition is a more stable classification in traumatic SCI.
Keywords
List of abbreviations:
AIS (American Spinal Injury Association Impairment Scale), ASIA (American Spinal Injury Association), DAP (deep anal pressure), ISNCSCI (International Standards for Neurological Classification of Spinal Cord Injury), NLI (neurological level of injury), 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: June 09, 2020
Footnotes
Supported in part by the National Institute on Disability, Independent Living, and Rehabilitation Research (grant nos. 90SI5026 and 90SI5024).
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
