Classification of the severity of acute spinal cord injury: implications for management

Sensory and motor function scales using a comprehensive neurological examination in emergency departments were developed during a 5-year prospective study of the epidemiology of acute spinal cord injury. Cross-classification of the scales on 133 patients identified 18.8 per cent who had severe motor impairment but minimal or no sensory loss. This discrepancy was not associated with older age or comorbidity but these patients tended to have a higher prevalence of fracture dislocations, hyperesthesia and Brown-Sequard Syndrome. The discrepancy between sensory and motor function was almost certainly due to the pathology of the cord lesion. Overall, motor function was more likely than sensory function to show improvement during the acute hospitalisation. This was especially true for patients admitted with good sensory but poor motor function. These patients need to be delineated soon after injury if we are to fully understand the aetiology of spinal cord injury and appropriately manage and evaluate different therapeutic modalities.