title: Patterns of Sacral Sparing Components on Neurologic Recovery in Newly Injured Persons With Traumatic Spinal Cord Injury.
abstract: OBJECTIVE
  To assess the patterns of sacral sparing and recovery in newly injured persons with traumatic spinal cord injury (SCI).
  
  
  METHODS
  Retrospective analysis of data from the national Spinal Cord Injury Model Systems (SCIMS) database for patients enrolled from January 2011 to February 2015.
  
  
  METHODS
  SCIMS centers.
  
  
  METHODS
  Individuals (N=1738; age ≥16y) with traumatic SCI admitted to rehabilitation within 30 days after injury with follow-up at discharge, at 1 year, or both.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  International Standards for Neurological Classification of Spinal Cord Injury examination results at admission and follow-up (discharge or 1y, or both).
  
  
  RESULTS
  Conversion from an initial American Spinal Injury Association Impairment Scale (AIS) grade A to incomplete status was 20% at rehabilitation discharge and 27.8% at 1 year, and was greater in cervical and low paraplegia levels (T10 and below) than in high paraplegia level injuries (T1-9). Conversion from AIS B to motor incomplete was 33.9% at discharge and 53.6% at 1 year, and the initial sparing of all sacral sensory components was correlated with the greatest conversion to motor incomplete status at discharge and at 1 year. For patients with initial AIS C, the presence of voluntary anal contraction (VAC) in association with other sacral sparing was most frequently observed to improve to AIS D status at discharge. However, the presence of VAC alone as the initial sacral sparing component had the poorest prognosis for recovery to AIS D status. At follow-up, regaining sacral sparing components correlated with improvement in conversion for patients with initial AIS B and C.
  
  
  CONCLUSIONS
  The components of initial and follow-up sacral sparing indicated differential patterns of neurologic outcome in persons with traumatic SCI. The more sacral components initially spared, the greater the potential for recovery; and the more sacral components gained, the greater the chance of motor recovery. Consideration of whether VAC should remain a diagnostic criterion sufficient for motor incomplete classification in the absence of other qualifying sublesional motor sparing is recommended.
authors.affiliation: Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ; Kessler Foundation, West Orange, NJ. Electronic address: skirshblum@kessler-rehab.com.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Kirshblum
authors.affiliation: Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ; Kessler Foundation, West Orange, NJ.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Botticello
authors.affiliation: Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ; Kessler Foundation, West Orange, NJ.
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Dyson-Hudson
authors.affiliation: Kessler Foundation, West Orange, NJ.
authors.forename: Rachel
authors.initials: R
authors.lastname: Byrne
authors.affiliation: Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Marino
authors.affiliation: Craig Hospital, Englewood, CO; Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Lammertse
mesh_terms: D000293:Adolescent; D000328:Adult; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000534:rehabilitation; D026741:Physical Therapy Modalities; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D012447:Sacrum / Q000503:physiopathology*; D013119:Spinal Cord Injuries / Q000145:classification* / Q000503:physiopathology / Q000534:rehabilitation*; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: Classification; Neurologic examination; Prognosis; Rehabilitation; Spinal cord injuries