Article

Prospective cross-sectional multicenter study. OBJECTIVE: To
evaluate the correlation, sensitivity, specificity and predictive values of S4-5
dermatome and the anorectal examination for determination of sacral sparing in
the International Standards for Neurological Classification of Spinal Cord Injury
(ISNCSCI) examination. SETTING: Two tertiary hospitals that specialize in
pediatric spinal cord injuries. METHODS: In all, 189 patients who were at minimum
3 month after spinal cord injury participated in complete ISNCSCI examinations.
All examiners completed training for the proper completion of the ISNCSCI
examination. Correlations and sensitivity/specificity analyses were conducted
between S4-5 dermatome testing and the anorectal examination. Results were
analyzed by age of patient, examiner, tetraplegia/paraplegia classification and
injury level (T10-S3, L1-S3 and S3). RESULTS: The correlation between S4-5
dermatome and anorectal sensation was moderate (0.62, P<0.001). Using the
anorectal examination as the gold standard, the sensitivity of S4-5 testing was
0.60 (0.49, 70) and specificity was 0.96 (0.90, 0.99). No single age group,
tester, level, or type of injury differed from the overall result. CONCLUSION: In
the pediatric population, the correlation between S4-5 and anorectal sensation
was lower than anticipated. The sensitivity of 0.62 for S4-5 testing and
diminished sensation between T10 and S3 suggests that anorectal testing may
either be a more sensitive representation of S4-5 function or activate an
alternative neuronal pathway that is perceived by the patient. Further
investigation into the validity of the sacral sparing components of the ISNCSCI
examination is warranted.

Langue : ANGLAIS