Clarifications of the Motor Level Definition in the International Standards for Neurological Classification of Spinal Cord Injury in Not Clinically Testable Myotomes.

Only 34 of 665 individuals had motor levels that differed between the two rules, so this is a rare situation rather than a routine classification problem. Functional independence data were very limited: SCIM III scores were available for only 8 of the people with no detectable ISNCSCI motor deficits, and only 3 people in the small subgroup with SCIM data were discussed. The study compared classification rules in existing records; it did not test patient outcomes, treatment, or whether one rule is clinically better. The authors note that motor levels outside the 10 tested myotomes are based on assumptions from sensory function, which remains conceptually debatable. Some unusual sensory patterns could be caused by conditions outside spinal cord injury, such as sensory polyneuropathy, or by documentation errors, but these were not systematically confirmed.

The authors declared no conflicts of interest. The supplied text does not state a funding source.

Do not read this as proof that one motor-level rule is better for patients. The disagreements were rare and did not change ASIA grades. The paper only shows that the current ISNCSCI definition is unclear in a small number of unusual sensory patterns.