Abstract：
STUDY DESIGN:Prospective cross-sectional multicenter study. OBJECTIVE:To evaluate the correlation, sensitivity, specificity and predictive values of S4-5 dermatome and the anorectal examination for determination of sacral sparing in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination. SETTING:Two tertiary hospitals that specialize in pediatric spinal cord injuries. METHODS:In all, 189 patients who were at minimum 3 month after spinal cord injury participated in complete ISNCSCI examinations. All examiners completed training for the proper completion of the ISNCSCI examination. Correlations and sensitivity/specificity analyses were conducted between S4-5 dermatome testing and the anorectal examination. Results were analyzed by age of patient, examiner, tetraplegia/paraplegia classification and injury level (T10-S3, L1-S3 and S3). RESULTS:The correlation between S4-5 dermatome and anorectal sensation was moderate (0.62, P<0.001). Using the anorectal examination as the gold standard, the sensitivity of S4-5 testing was 0.60 (0.49, 70) and specificity was 0.96 (0.90, 0.99). No single age group, tester, level, or type of injury differed from the overall result. CONCLUSION:In the pediatric population, the correlation between S4-5 and anorectal sensation was lower than anticipated. The sensitivity of 0.62 for S4-5 testing and diminished sensation between T10 and S3 suggests that anorectal testing may either be a more sensitive representation of S4-5 function or activate an alternative neuronal pathway that is perceived by the patient. Further investigation into the validity of the sacral sparing components of the ISNCSCI examination is warranted.
journal_name
Spinal Cordjournal_title
Spinal cordauthors
Samdani A,Chafetz RS,Vogel LC,Betz RR,Gaughan JP,Mulcahey MJdoi
10.1038/sc.2010.144subject
Has Abstractpub_date
2011-03-01 00:00:00pages
352-6issue
3eissn
1362-4393issn
1476-5624pii
sc2010144journal_volume
49pub_type
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