The American Spinal Injury Association (ASIA) classification[1] remains the gold standard for assessment of the level and severity of a spinal cord injury as it can predict recovery of motor function and autonomic functions such as bowel, bladder, cardiovascular, respiratory, and reproductive functions[2] if there are no complicating medical or physical conditions that interfere with recovery. Prognosis is important to patients and the physicians who manage spinal cord injury which will allow for the timely consideration and referral for the use of surgical interventions that may improve function and independence which include phrenic stimulators, nerve transfers, tendon transfers, and other developing techniques:
ASIA A: Complete, no motor or sensory function is preserved below the level of the injury, including the sacral segments S4 – S5
ASIA B: Incomplete Sensory, but not motor function is preserved below the neurological level of injury, and includes the sacral segments S4 – S5
ASIA C: Incomplete, motor function is preserved below the neurological level of injury, but more than half of the key muscles below the level have a muscle grade less than 3 (i.e. unable to move against gravity)
ASIA D: Incomplete, motor function is preserved below the neurological level of injury, and at least half the key muscles below the injury level have a muscle grade of 3 or more (i.e. joints can be moved against gravity
ASIA E: Normal, motor and sensory functions are normal
What does Dr. Michael Fehlings, MD, Ph.D., describe by the evidence-based studies as to outcomes and timeframes of decompression following acute spinal cord injury?
“To assist clinicians in the management of patients with acute SCI, our multidisciplinary, international team recently sought to address… the role and timing of surgical decompression. …(and) There was a strong consensus around the recommendation that surgery for acute SCI be undertaken within 24 hours when “medically feasible.”[3]
[1] Rudiger Rupp, et al. International Standards for Neurological Classification of Spinal Cord Injury (Revised 2019).
[1] van Middendorp JJ, Goss B, Urquhart S, Atresh S, Williams RP, Schuetz M. Diagnosis and prognosis of traumatic spinal cord injury. Global Spine J. 2011;1:1–8.
[1] Fehlings, Evaniew, Kurpad, Skelly, Tetreault, Kwon. Editorial: The AO Spine/Praxis Spinal Cord Institute clinical practice guidelines for acute spinal cord injury: interpretation and implications for clinical practice. J Neursurg Spine. Vol. 42, April 2025.
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