The anorectal examination is an unnecessary part of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) in almost all cases. Its requirement in the ISNCSCI is based on limited data and a modification of the “sacral sparing” definition of SCI proposed by Waters [1]. The reliability of deep anal sensation and voluntary anal contraction (VAC) are modest, and the validity of deep anal pressure (DAP) as an indicator of somatic sensation has been questioned. Finally, the predictive validity of “sacral sparing” as defined in the ISNCSCI is limited.

The basis of the inclusion of DAP and VAC in the ISNCSCI is said to be from Waters [1], who reported that a change in classification of completeness was unidirectional using his proposed sacral sparing definition, and bidirectional using the Frankel scale definition (sparing of sensory or motor function more than three levels below the neurological level of injury, NLI). Waters [1], however, did not include DAP in his definition of sacral sparing, and VAC was not the sole criterion for motor sparing! He defined motor sparing as motor function in the VAC or the toe flexor (TF) muscles. Sensory sacral sparing was defined as “presence of sensation in the perinium at the anal mucocutaneous junction, glans penis or clitoris [1].” The article did not describe which component(s) were present in persons classified as incomplete by sacral sparing.

Log in or create a free account to read this content

Gain free access to this article, as well as selected content from this journal and more on nature.com

Access through your institution

or

Sign in or create an account
Continue with Google
Continue with ORCiD