Classifying incomplete spinal cord injury syndromes: Algorithms based on the International Standards for Neurological and Functional Classification of.

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Classifying incomplete spinal cord injury syndromes: Algorithms based on the International Standards for Neurological and Functional Classification of spinal cord injury patients Keith C. Hayes, PhD, Jane T.C. Hsieh, MSc, Dalton L. Wolfe, PhD, Patrick J. Potter, MD, Gail A. Delaney, MD Archives of Physical Medicine and Rehabilitation Volume 81, Issue 5, Pages 644-652 (May 2000) DOI: 10.1016/S0003-9993(00)90049-2 Copyright © 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 1 SCI Syndromes. Clinical syndromes: Central cord syndrome: A lesion, occurring almost exclusively in the cervical region, that produces sacral sensory sparing and greater weakness in the upper limbs than in the lower limbs. Brown-Séquard syndrome: A lesion that produces relatively greater ipsilateral proprioceptive and motor loss and contralateral loss of sensitivity to pain and temperature. Anterior cord syndrome: A lesion that produces variable loss of motor function and of sensitivity to pain and temperature while preserving proprioception. Posterior cord: A lesion involving the dorsal columns that produces loss of proprioception while preserving other sensory and motor function (ASIA Standards for Neurological Classification of Spinal Injury Patients [Revised] 1992). Conus medullaris syndrome: Injury of the sacral cord (conus) and lumbar nerve roots within the spinal canal, which usually results in an areflexic bladder, bowel, and lower limbs, with lesions as at B in the figure. Sacral segments may occasionally show preserved reflexes, eg, bulbocavernosus and micturition reflexes, with lesions as at A in the figure. Cauda equina syndrome: Injury to the lumbosacral nerve roots within the neural canal resulting in areflexic bladder, bowel, and lower limbs, with lesions as at C in the figure. (Adapted with permission.7,8) Archives of Physical Medicine and Rehabilitation 2000 81, 644-652DOI: (10.1016/S0003-9993(00)90049-2) Copyright © 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 2 Individual algorithms for incomplete SCI syndrome classification based on sensory and motor scores from the International Standards for Neurological and Functional Classification of Spinal Cord Injury Patients. NLI, neurologic level of injury. Archives of Physical Medicine and Rehabilitation 2000 81, 644-652DOI: (10.1016/S0003-9993(00)90049-2) Copyright © 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 3 Operational definitions for the individual algorithms for incomplete SCI syndrome classification. NLI, neurologic level of injury; LT, light touch; LE, lower extremity; a, average; L, left; R, right; UE, upper extremity; T, threshold; PP, pinprick; MS, motor score; AIS, ASIA impairment scale. Archives of Physical Medicine and Rehabilitation 2000 81, 644-652DOI: (10.1016/S0003-9993(00)90049-2) Copyright © 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 4 Composite, differential-allocation algorithm for classifying incomplete SCI syndrome: Order A, the decision node for upper-limb versus lower-limb motor loss precedes the node for asymmetry of motor loss. NLI, neurologic level of injury. Archives of Physical Medicine and Rehabilitation 2000 81, 644-652DOI: (10.1016/S0003-9993(00)90049-2) Copyright © 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 5 Composite, differential-allocation algorithm for classifying incomplete SCI syndrome: Order B, the decision node for asymmetry of motor loss precedes the node for upper-limb versus lower-limb motor loss. NLI, neurologic level of injury. Archives of Physical Medicine and Rehabilitation 2000 81, 644-652DOI: (10.1016/S0003-9993(00)90049-2) Copyright © 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 6 Classification outcomes (rates) for the individual algorithms: In central cord syndrome fewer subjects are classified as the threshold for upper-limb versus lower-limb motor loss increases. In Brown-Séquard syndrome classification depends on the degree of motor loss asymmetry. In anterior cord syndrome the number of subjects classified depends on the motor loss threshold (MT), expressed as a percentage (Z axis), and the thresholds for light touch (LT > T) and pin prick (PP < T). In posterior cord syndrome the classification rate depends primarily on the threshold for motor loss (MT). Archives of Physical Medicine and Rehabilitation 2000 81, 644-652DOI: (10.1016/S0003-9993(00)90049-2) Copyright © 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions