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Patterns of Sacral Sparing Components on Neurologic Recovery in Newly Injured Persons With Traumatic Spinal Cord
Steven C Kirshblum1, Amanda L Botticello2, Trevor A Dyson-Hudson2
1Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ; Kessler Foundation, West Orange, NJ.
Archives of Physical Medicine and Rehabilitation
|March 15, 2016
Summary
Sacral sparing in spinal cord injury (SCI) predicts recovery. More initial sacral sparing and regaining sacral components correlate with better motor function outcomes in traumatic SCI patients.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Spinal Cord Injury Research
Background:
- Traumatic spinal cord injury (SCI) significantly impacts neurological function.
- Understanding predictors of recovery is crucial for patient management and rehabilitation.
- Sacral sparing, the preservation of function in the sacral region, is a key indicator.
Purpose of the Study:
- To analyze patterns of sacral sparing and neurological recovery in individuals with recent traumatic SCI.
- To identify the relationship between initial sacral sparing and subsequent motor function improvement.
- To evaluate the impact of regaining sacral sparing components on recovery.
Main Methods:
- Retrospective analysis of 1738 patients with traumatic SCI from the national Spinal Cord Injury Model Systems (SCIMS) database.
- Data collected between January 2011 and February 2015, including patients admitted for rehabilitation within 30 days of injury.
- Assessment of neurological status using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) at admission and follow-up (discharge and/or 1 year).
Main Results:
- Conversion from initial ASIA Impairment Scale (AIS) Grade A to incomplete status occurred in 20% at discharge and 27.8% at 1 year, with higher rates in cervical and low paraplegia.
- Initial sparing of all sacral sensory components strongly correlated with the greatest conversion to motor incomplete status (AIS B to incomplete).
- Regaining sacral sparing components at follow-up correlated with improved neurological conversion for patients with initial AIS B and C injuries.
Conclusions:
- Initial and follow-up sacral sparing patterns predict differential neurological outcomes in traumatic SCI.
- Greater initial sacral sparing indicates a higher potential for recovery, while regaining sacral components enhances motor recovery.
- The diagnostic sufficiency of voluntary anal contraction (VAC) alone for motor incomplete classification warrants further consideration.
