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Review Question - QID 403

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QID 403 (Type "403" in App Search)
A 16-year-old male is involved in a diving accident six months ago that leads to a spinal cord injury. On physical exam he has 5 out of 5 deltoid and biceps strength. He has good brachioradialis muscle tone and 5 out of 5 bilateral wrist extension. He has 0 out of 5 wrist flexion and triceps strength. He has no anal sphincter tone, absent perianal sensation, absent lower extremity sensation, and an intact bulbocavernosus reflex. He has no motor tone in his lower extremities. How would you define this patients neurologic deficit.

Incomplete C5 spinal cord injury (ASIA A)

1%

58/4099

Complete C5 spinal cord injury (ASIA E)

2%

68/4099

Complete C6 spinal cord injury (ASIA A)

65%

2656/4099

Complete C7 spinal cord injury (ASIA A)

25%

1045/4099

Incomplete C7 spinal cord injury (ASIA B)

6%

246/4099

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According to the ASIA Classification of Spinal Cord Injuries, this patients neurologic deficit would be best described as a Complete C6 spinal cord injury (ASIA A).

There are three general steps to define a spinal cord injury using the ASIA classification system.

Step 1: Identify the neurologic level, which is described as the lowest segment where motor and sensory function is normal on both sides. Because this patient has normal function at C6 (brachioradialis and wrist extension), and no function at C7 (triceps and wrist flexion), his last normal functional level is C6. Therefore his neurologic level is C6.

Step 2: Determine if injury is complete or incomplete. Complete injuries are defined as no voluntary anal contraction AND 0/5 distal motor AND 0/2 distal sensory scores (no perianal sensation) AND intact bulbocavernosus reflex (patient not in spinal shock). Therefore, this patient has a complete injury.

Step 3: Assign ASIA impairment score. Because this patient has a complete injury, his ASIA impairment score is ASIA A.

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