Sacral examination in spinal cord injury: Is it really needed?

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Clinical Neurology

Background:

• Accurate assessment of sacral sparing is crucial for managing chronic spinal cord injury (SCI).
• Current clinical practice often relies on physical examinations to evaluate S4-5 motor and sensory function.
• The utility of patient self-report measures in this context requires further investigation.

Purpose of the Study:

• To evaluate the predictive accuracy of a self-report survey for sacral motor and sensory function in patients with chronic SCI.
• To compare patient self-reported sacral function with objective sacral examination findings.
• To determine if self-reported sacral sparing correlates with American Spinal Cord Injury Association Impairment Scale (AIS) categories.

Main Methods:

• A prospective, single-blinded study involving 116 adult patients with chronic SCI (> 6 months).
• Patients completed a self-report survey on sacral function (light touch, pinprick sensation, deep anal pressure, voluntary anal contraction).
• Survey results were compared with sacral examination findings and stratified by AIS category.

Main Results:

• Overall Positive Predictive Values (PPV) ranged from 48% (voluntary anal contraction) to 73% (deep anal pressure).
• Negative Predictive Values (NPV) ranged from 92% (voluntary anal contraction) to 100% (light touch).
• Patients with AIS-A demonstrated 100% NPV for all sacral functions, while those with AIS-D showed 100% PPV across all categories.

Conclusions:

• Patient self-report of sacral sparing can predict the absence of sensation in AIS-A patients and the presence of sensation in AIS-D patients.
• However, the overall self-report of sacral motor and sensory function is not sufficiently predictive for accurate clinical classification.
• Further research may explore integrating self-report data with clinical assessments for a more comprehensive evaluation.