Classification challenges of the 2019 revised International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)

Steven Kirshblum,Mary Schmidt Read,Rüdiger Rupp

doi:10.1038/s41393-021-00648-y

Abstract

Study designRetrospective review of ISNCSCI datasets.ObjectivesTo discuss the correct classification of ISNCSCI datasets considered as challenging.SettingInternational expert collaboration.MethodsThe International Standards Committee of the American Spinal Injury Association (ASIA) receives challenging case scenarios regarding the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI). Among those cases received, sample cases representing different categories of typical classification difficulties were identified by members of the International Standards committee.ResultsFrom the cases received, five sample cases were identified as representative for publication. These cases are related to the correct classification in the presence of non-SCI related conditions, the determination of motor zones of partial preservation in regions with no myotomes to test, the classification of the ASIA Impairment Scale in patients with substantial motor function below the motor level but no sacral sparing, the inclusion of non-key muscle functions in the classification of sensory incomplete individuals, and the correct classification of individuals with an amputation.ConclusionPresenting cases with challenging classifications, along with responses and explanations, will serve spinal cord injury professionals to better understand and utilize the ISNCSCI classification. As the ISNCSCI endorsed by ASIA and the International Spinal Cord Society (ISCoS) evolves over time, such resources are important to clarify inquiries from the spinal cord injury community and to understand the rationale for revisions.

Highlights

As the ISNCSCI endorsed by ASIA and the International Spinal Cord Society (ISCoS) evolves over time, such resources are important to clarify inquiries from the spinal cord injury community and to understand the rationale for revisions
2019, a call for challenging cases to be submitted to the committee was communicated via e-mail to all ASIA
What is the best way to classify a case when there is a myotome not grading as normal due to an old non-SCIrelated injury, with the motor score of that specific myotome impacting the determination of the ASIA Impairment Scale (AIS) (Fig. 1)? In this case, does the AIS need to be recorded as “ND”?

Summary

Introduction

Since the introduction of the original Standards for the Classification of Spinal Cord Injuries by the American. Kessler Institute for Rehabilitation, West Orange, NJ, USA. The ISNCSCI endorsed by ASIA and the International Spinal Cord. Society (ISCoS) is the most widely used classification in the field of spinal cord injury (SCI) medicine, and describes the examination and definitions to be used for clinical and research purposes around the world. The ASIA International Standards Committee often receives inquiries regarding the ISNCSCI. 2019, a call for challenging cases to be submitted to the committee was communicated via e-mail to all ASIA membership. These questions are usually handled by the

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