International Standards for Neurological Classification of Spinal Cord Injury: Classification Questions and Cases.
Brittany Snider, Steven Kirshblum, Ruediger Rupp and 10 others
PMID 40873960WHAT IT FOUND
Consensus guidance clarifies how to classify spinal cord injuries when patients have had tendon transfers, use spinal cord stimulation, or have nontraumatic causes.
It specifies when to mark exams as intact or incomplete and how to document prior levels.
Key findings
01For patients who improve to AIS E grade, examiners should record 'INT' for levels but document the previous neurological level of injury in the comments box.
02Motor scores affected by tendon or nerve transfers should be tagged with an asterisk, and the classification should rely on the presumed pre-surgery function rather than the surgically altered strength.
03The ISNCSCI examination should be performed without active neuromodulation or neuroprostheses to accurately assess residual spinal cord function, as transient effects during stimulation should not change the classification.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This is a consensus guideline and case illustration, not an empirical study with patient outcomes. The recommendations rely on clinical judgment for assumptions about pre-surgery function, which can vary between examiners. The duration of carryover effects from neuromodulation is not fully understood, making timing of exams critical.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not assume that an AIS E classification indicates a complete return to normal function. Patients may still have significant neurological sequelae such as autonomic dysfunction, spasticity, or weakness in muscles not tested by the ISNCSCI.