Abstract
The ASIA Impairment Scale (AIS) is considered the gold standard for evaluating spinal cord injuries. This scoring system is based on remaining motor and sensory function. Fine touch is representative of the dorsal column-medial lemniscus pathway, which also provides proprioceptive sensation, two-point discrimination and vibration sensation. This report suggests that the assessment of multiple sensory modalities could improve the reliability and validity of the AIS scoring system. We report on a traumatic spinal cord injury patient classified as AIS grade A but who had retained joint position sensation. Computed tomography revealed a fracture dislocation of the C6 and C7 vertebra with 100% canal compromise. He subsequently underwent posterior open reduction and instrumentation with posterior fusion at the C6 and C7 level. At the five year follow-up, he presented with significant neurological improvement
Highlights
The ASIA Impairment Scale (AIS) is considered the gold standard for evaluating spinal cord injuries
While fine touch and proprioceptive sensation are located in the same pathway, dissociation between these two modalities has been reported.[10,11] which suggests the need for assessment of multiple sensory modalities in spinal cord injuries, not just pin-prink and find touch sensation
The service orthopedist recognized the preservation of joint position sensation and suspected an incomplete spinal cord injury
Summary
The ASIA Impairment Scale (AIS) is considered the gold standard for evaluating spinal cord injuries. The American Spinal Injury Association (ASIA) Impairment Scale (AIS) is a tool for grading the severity of spinal cord injuries.[1] a number of studies have questioned the reliability and validity of this scoring system, it remains the gold standard tool for spinal cord injury evaluation.[1,2,3] Under this system, motor function is assessed by 10 key muscles while sensory function is assessed by pin-prick and fine touch sensation with classification as grade A (complete spinal cord injury) to grade E (normal spinal cord).[4] a direct association between AIS and neurological outcome has been observed,[5] sensory function consists of mechanoreceptor, proprioceptor, temperature receptor and nociceptor modalities. Omission of any one of these modalities could affect the reliability of the AIS scoring system.[6,7,8,9] While fine touch and proprioceptive sensation are located in the same pathway, dissociation between these two modalities has been reported.[10,11] which suggests the need for assessment of multiple sensory modalities in spinal cord injuries, not just pin-prink and find touch sensation.
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