1. Standard Neurological Classification of Spinal Cord Injury by
Greg Nemunaitis, MD
4. Vertebral artery
9. Tetraplegia: The impairment or loss of motor and/or sensory function in the cervical segments of the spinal cord due to damage of neural elements within the spinal canal.
Paraplegia: The impairment or loss of motor and or sensory function in the thoracic, lumbar, or sacral segments of the spinal cord due to damage of neural elements within the spinal canal. Dermatome: The area of skin innervated by one sensory nerve root.
Myotome: The collection of muscles innervated by one motor nerve root.
10. Neurological Level of Injury: The most caudal segment of the spinal cord with normal motor and sensory function on both sides.
Skeletal Level: The radiographic level of greatest vertebral damage.
11. Incomplete Injury: If there is preservation of motor and or sensory function in the lowest sacral segment.
Complete Injury: The absence of motor and/or sensory function in the lowest sacral segment.
Zone of Partial Preservation: Dermatomes and myotomes caudal to the neurological level that remain partially innervated (this term is only used in complete injuries).
14. ASIA Sensory Testing Sensory Testing:
0 = Absent
1 = Impaired
2 = Normal
NT = Not testable
15. ASIA Dermatones C2-Occipital Protruberance
C3 Supraclavicular fossa
C4 A.C. Joint
C5 Lateral antecubital fossa
C7 Middle finger
C8 Little finger
T1 Medial antecubital fossa
T2 Apex of the axilla
T4 Nipple line
T12 Inguinal ligament
L2 Mid thigh
L3 Medial femoral condyle
L4 Medial Malleolus
L5 3rd MTP joint
S1 Lateral heel
S2 Mid popliteal fossa
S3 Ischial tuberosity
S4-5 Perianal area
17. ASIA Motor Testing 0 = No movement
1 = Trace contraction
2 = Full AROM gravity eliminated .
3 = Full AROM against gravity
4 = Full AROM against gravity with resistance
5 = Normal power
18. ASIA Myotomes C5 Elbow flexors
C6 Wrist extensors
C7 Elbow extension
C8 Finger flexors
T1 5th digit abduction
L2 Hip flexion
L3 Knee extension
L4 Ankle dorsiflexion
L5 Long toe extension
S1 Ankle plantar flexion
20. ASIA Impairment Scale Spinal Cord Medicine Principles and Practice Vernon Lin:
Count the number of key muscles below the neurologic level for each side of the body
If less than ½ have a motor score of 3 or more then AIS grade is C, if ½ or more have
a motor score of 3 or more then AIS grade is D.
ASIA Reference Manual
Complete Injuries: The absence of motor and sensory function in the lowest
Zone of Partial Preservation: dermatomes and myotomes caudal to the neurologic
level of injury that remain partially innervated
ASIA D at least ½ of the key muscles below the neurologic level of injury have a
grade 3 or better
ASIA C must have motor function in 3 or more segments below the level of injury
The presence of voluntary contraction of any muscle (even non-key muscles including
the anal sphincter) indicates an AIS score of C
ASIA C motor function must extend more than two levels caudal to the motor level
International Standards for Neurological Classification of SCI 2002:
ASIA C or D must be incomplete and have sparing of Motor function more than 3
levels below the motor level or have voluntary anal contraction.
ASIA IScOS form:
ASIA D at least half of the key muscles below the (single) neurological level are grade 3 or better
24. ASIA Impairment Scale A = Complete: No motor or sensory function in the lowest sacral segment.
B = Incomplete: Sensory but not motor function is preserved in the lowest sacral segment.
C = Incomplete: Less than ½ of the key muscles below the (single) neurological level have a grade 3 or better.
D = Incomplete: At least ½ of the key muscles below the (single) neurological level have a grade 3 or better.
E = Sensory and motor function are normal.
25. Snappers ASIA C in addition to being incomplete, must have motor function more than 3 levels below the motor level on a given side.
The presence of voluntary contraction of any muscle (even non-key muscles including the anal sphincter) can indicate an AIS score of C.
26. Clinical Syndromes Central Cord Syndrome: Cervical injury with sacral sparing and greater weakness in the arms than the legs.
Brown-Sequard Syndrome: An injury that causes greater ipsilateral weakness and proprioceptive loss and contralateral pain and temperature loss.
Anterior Cord Syndrome: Injury to the spinal cord causing loss of pain and temperature sensation with preserved proprioception.
Posterior Cord Syndrome: Injury to the spinal cord causing loss of proprioception with preserved pain and temperature sensation.
Conus Medullaris Syndrome: Injury of the sacral conus and lumbar nerve roots
Cauda Equina Syndrome: Injury to the lumbosacral nerve roots within the neural canal.