CLINICAL MANIFESTATIONS OF ACUTE SPINAL CORD INJURY
Grade A denotes a complete injury,Grades B,C,and D denote varying levels ofincompleteinjury,and Grade E denotes a patient with nor-mal motor and sensory spinal cord function.A complete injury (Grade A) is now defined asabsence ofsensory and motor function in thelowest sacral segment,as originally described by Waters et al.
A Grade B patient has sensory preservation only below the level ofinjury.Grades C and D were originally described by Frankel et al
as preserved motor function being“useless”in Grade C and “useful”in Grade D.The new scale defines the function more pre-cisely on the basis ofthe Medical ResearchCouncil muscle grading system:
in Grade C themajority ofkey muscles below the neurologicallevel have a muscle grade oflower than 3,andin Grade D the majority ofkey muscles below the neurological level have a muscle grade of3 orgreater.The latter modifications are based on theclassification ofTator et al.
The new ASIA/IMSOP grading scale im-proves the ability to distinguish precisely be-tween complete and incomplete injuries.Tomake this distinction,the clinician must test
ID IN THE
•Hypotension and bradycardia occur in spinalshock •Paradoxical respiration·Low body temperature and high skin tempera-ture•Priapism•Bilateral paralysis ofarms and legs,especially flaccid•Bilateral paralysis ofeither arms only or armsmore than legs,especially flaccid•Bilateral paralysis oflegs,especially flaccid•Lack ofresponse to painful stimuli•Detection ofan anatomic level in response topainful stimuli•Painful stimulation produces only head move-ment or facial grimacing•Sweating level•Horner’s syndrome•Brown-Séquard syndrome
IMSOP ASIA/IMSOP I
ASED ON THE
Complete injuryNo motor or sensory function is preserved in the sacralsegments S4–5.
Incomplete injurySensory but not motor function is preserved below theneurological level and extends through the sacral seg-ments S4–5.
Incomplete injuryMotor function is preserved below the neurologicallevel,and the majority ofkey muscles below the neuro-logical level have a muscle grade less than 3.
Incomplete injuryMotor function is preserved below the neurologicallevel,and the majority ofkey muscles below the neuro-logical level have a muscle grade 3 or greater.
NormalMotor and sensory function are normal.