Analyses of 94 consecutive spinal cord injury patients using ASIA definition and modified frankel score classification

Abstract

Serial neurological examinations were analysed on 94 consecutive spinal cord injury (SCI) patients admitted for rehabilitation to the Swiss Paraplegic Center at the Clinic Balgrist Zurich, Switzerland, between 1987 and 1992. Patients’ data were examined adopting ASIA and modified Frankel definitions in order to compare the two classifications in terms of consistency and prognostic value. The modified Frankel definition was subdivided into five categories (A, B, C, D and E). On admission (discharge) 43 (37) patients were classified as Frankel A, 23 (11) patients in group B, 26 (42) patients in group C, 2 (2) patients as Frankel D and 0 (2) patients in group E. A qualitative analysis of the results on the base of a maximal score of 100 points (A = 0, B = 25, C = 50, D =75 and E = 100 points) suggested a mean score improvement from 21.5 (±22.5) to 29.0 (±26.3) or 7.5 (±7.1). regarding all 94 patients during follow up (admission/discharge). The median improvement was one modified Frankel grade (A/B to B/C). No detailed assessments were yielded concerning motor and sensory functions. Using ASIA definition, a continuous numerical score of motor and sensory function was observed. Recovery during follow up was determined by detailed motor and sensory function. For all 94 patients (quadriplegics and tetraplegics), the average motor recovery according to the ASIA definition was 9.4 (±9.6). The mean ASIA motor score improved from 52.2 (±17.3) on admission to 61.6 (±17.9) on discharge. Light touch increased by 7.0 (±10.3) from 72.7 (±22.3) to 79.7 (±22.7) and pinprick sensory function by 7.1 (±13.6) from 69.2 (±21.8) to 76.3 (±22.2). Change in status was progressively unidirectional using both definitions. Comparing the ASIA guidelines with modified Frankel classification there was an unambiguous benefit using the new definition of ASIA, as a gradual change of motor and/or sensory function was more clearly documented for all cases by ASIA. Using modified Frankel score definition, the patient’s classification may be unchanged, regardless of whether the status improved or remained stable. This was not the case using ASIA definition. It was not the intention in this paper to assess and compare the treatment of acutely spinal cord injured patients by (a) nonoperative and (b) operative treatment. © 1994 International Medical Society of Paraplegia.