We have read with great interest this challenging study by Previnaire et al.1 evaluating the completeness of sympathetic injury in 34 tetraplegic and 47 paraplegic patients using vasomotor responses (skin axon-reflex vasodilatation (SkARV). Applying mechanical stimulation to the skin on both sides of the trunk, the sympathetic level, the sympathetic completeness of injury and the ‘excitability’ of the isolated spinal cord were assessed. The authors conclude that there was an ‘excellent correspondence between ASIA A and a complete sympathetic lesion, which was always found at or below the lesion.’

After reading this article carefully, we would like to raise some questions and add a few comments concerning the design and the validity of the study's outcome.

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