ASIA a (sensory and motor complete) is not different than ASIA B (sensory incomplete, motor complete) in gunshot related spinal cord injury.

Publication date: Available online 10 July 2017
Source:The Spine Journal
Author(s): Eric McCoy, Nima Eftekhary, Kenneth Nwosu, Dudley Fukunaga, Charles Liu, Kevin Rolfe
Background ContextWe receive a large number of spinal cord injury (SCI) patients due to penetrating gunshot wounds (GSW) at our national rehabilitation center. Though many patients are labeled American Spinal Injury Association (ASIA) B sensory incomplete due to sensory sparing, especially deep anal pressure, with purported prognostic value, we have not observed a clinical difference from ASIA A completes. We hypothesized that sensory sparing, if meaningful, should reduce the occurrence of pressure ulcers.PurposeTo determine if ASIA classifications A and B are important distinctions for patients suffering from spinal cord injuries secondary to civilian gunshot woundsStudy Design/SettingRetrospective chart review was performed on all civilian gunshot induced spinal cord injury patients transferred to Rancho Los Amigos Rehabilitation Center between 1999 and 2014. Outcome measures were occurrence of pressure ulcers and surgical intervention for pressure ulcers.Patient Sample487 patients who sustained civilian gunshot wounds to the spine and were provided care at Rancho Los Amigos Rehabilitation Center from 2001 through 2014Outcome measuresOccurrence of pressure ulcers and surgical intervention for pressure ulcers among patients who suffered civilian induced gunshot wounds to the spine.MethodsRetrospective chart review identified 487 spinal cord injuries due to gunshot wounds that were treated at Rancho Los Amigos from 2001-2014. Injury characteristics including ASIA classification, pressure ulcers, and pressure ulcer surgeries were recorded. Comprehensive surgical data was obtained for all patients. Chart reviews and telephone interviews were performed to determine the occurrence of any pressure ulcers and pressure ulcer surgeries. Statistical analysis was performed to compare data by spinal region and ASIA grade. There were no conflicts of interest from any of the authors and there was no funding obtained for this study.ResultsThere was no statistical difference for cervical ASIA A's vs. B's for the occurrence of pressure ulcers or the percentage requiring surgery nor for thoracic A's vs. B's (Table 1). Grouped, there was a statistically higher occurrence of pressure ulcers in cervical A/B's vs. thoracic A/B's, but a higher rate of surgery for thoracic A/B's. Lumbosacral cauda equina levels were not statistically different in occurrence of pressure ulcers or pressure ulcer surgery by ASIA grade A-D. Overall, when grouped C1-T12, cord level cervicothoracic A's and B's were statistically equivalent. C1-T12 cord level C/D's with motor sparing had statistically lower occurrence and need of surgery for pressure ulcers and were equivalent to lumbosacral cauda equina level A-D's.Conclusion:ASIA A and B distinctions are not meaningful at spinal cord levels in the cervicothoracic spine due to gunshot wounds as shown by similar occurrence of pressure ulcers and pressure ulcer surgery and should be treated as if the same. Meaningful decrease of pressure ulcers at cord levels does not occur until there is motor sparing ASIA C/D. Furthermore, cauda equina lumbosacral injuries are lower risk which is independent of ASIA grade A-D and statistically equivalent to cord level C/D's. Motor sparing at cord levels or any cauda equina level is most determinative neurologically for the occurrence of pressure ulcers or pressure ulcer surgery.



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