Year, Volume, Issue, Page(s):16, 97, 10, 1647-1655
Study assessed the patterns of sacral sparing and recovery in newly injured individuals with traumatic spinal cord injury (SCI) admitted to rehabilitation centers within 30 days after injury with follow-up at discharge, at 1 year, or both. The International Standards for Neurological Classification of Spinal Cord Injury examination results at admission and follow-up were obtained from 1,738 participants enrolled in the SCI Model Systems database January 2011 to February 2015. Results showed that conversion from an initial American Spinal Injury Association Impairment Scale (AIS) grade A to incomplete status was 20 percent at rehabilitation discharge and 27.8 percent 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 percent at discharge and 53.6 percent 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. The components of initial and follow-up sacral sparing indicated differential patterns of neurologic outcome in patients 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.