International Standards for Neurological Classification of Spinal Cord Injury: Classification Questions and Cases

BACKGROUND: The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) have been refined through the years and continue to evolve with advances in the field. The International Standards Committee of the American Spinal Injury Association (ASIA) is responsible for maintaining, continually reviewing, and updating the ISNCSCI. Questions from spinal cord injury (SCI) professionals are frequently submitted to ASIA for review by the International Standards Committee.

METHODS: Of the questions submitted to the International Standards Committee, 5 were selected for this article, as they relate to common areas of confusion, address challenging classification concepts, and have not previously been described. Representative cases were also created to reinforce classification rules and the committee's recommendations.

CASES: The 5 questions/cases address ISNCSCI classification in the setting of (1) AIS E grade, (2) tendon transfer, (3) spinal cord stimulation, (4) nontraumatic SCI (ntSCI) etiology, and (5) AIS D grade (vs. AIS B) based on the presence of non-key muscle function. Each case includes a detailed review of the correct classification components and thorough discussion of the impact the corresponding question has on the classification.

CONCLUSION: The International Standards Committee provides answers to questions about ISNCSCI classification. The scenarios presented in this article address important classification rules and challenging concepts that have not previously been described. This article can serve as a useful reference when similar cases are encountered in clinical and research settings.