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ASIA A
1%
36/4006
ASIA B
18%
719/4006
ASIA C
73%
2913/4006
ASIA D
7%
299/4006
ASIA E
0%
15/4006
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This patient is presenting with an ASIA C high thoracic level injury. The ASIA classification is used to determine severity of injury. ASIA A is a complete spinal cord injury. ASIA B is characterized by preserved sensory function but no motor function below the neurological level. ASIA C is characterized by preserved motor function below the neurological level, but more than half of key muscles below the neurological level have a muscle grade less than 3. ASIA D is characterized by preserved motor function below the neurological level, and at least half of key muscles below the neurological level have a muscle grade of 3 or more. ASIA E is a normal exam. Waters et al. followed 148 patients prospectively and demonstrated that no individual presenting with a complete neurologic level of injury above T9 ever regained any lower extremity motor function. Patients with a complete neurologic level below T9 had some return of function. One fifth of patients with complete injuries below T12 were eventually able to ambulate using conventional orthoses and crutches. Harrop et al. reviewed 150 patients treated over a 10 year period with a spinal cord injury between T4 and S5. Patients were stratified based on level of injury, initial American Spinal Injury Association (ASIA), age, race, and etiology. A total of 92.9% of lumbar (conus) patients neurologically improved one ASIA level or more compared with only 22.4% of thoracic or thoracolumbar spinal cord-injured patients. Illustration A is the ASIA worksheet that helps to classify a spinal cord injury. Illustration B shows the ASIA classification in chart format.
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