Spinal Cord Injury Classification Systems

Introduction to Classification Systems

• The American Association of Neurological Surgeons recommends using the ASIA system as the gold standard for neurological classification of spinal cord injury, which should be used consistently across all phases of care from acute to rehabilitation 1, 2
• The ASIA motor and sensory scores are extremely important for assessing small increments in recovery, with the entry AIS grade being the strongest predictor of functional outcomes 2, 3

Classification System Details

• The ASIA system has major advantages, including a more accurate definition of complete SCI and improved methods for determining motor and sensory scores 2
• The Modified Benzel Classification system has seven grades of neurological severity, but it is not recommended because it cannot be assessed in the acute phase and violates the principle of using the same grading system across all care phases 1, 2
• The Sunnybrook system expands ASIA Grades C and D to reduce ceiling effects, with grades 2, 3, 4, and 5 encompassing ASIA Grade C, and grades 6, 7, 8, and 9 encompassing ASIA Grade D 1, 2

Prediction and Outcome Assessment

• Abductor hallucis motor dysfunction serves as a specific predictor of neurological recovery in thoracolumbar fractures 3
• The Walking Index in Spinal Cord Injury and Spinal Cord Independence Measure are validated functional outcome measures that must complement neurological grading systems to address patient priorities, including bowel, bladder, and sexual function recovery 4
• Ankle spasticity assessment is highly accurate in predicting neurogenic bladder dysfunction type in thoracolumbar fracture patients 3, 5

Treatment Stratification

• Accurate classification is essential for stratifying patients in interventional trials and setting realistic rehabilitation goals, with the same neurological grading system being used for all phases of care from acute to rehabilitation in clinical studies 1, 2