ANALYSES OF 94 CONSECUTIVE SPINAL-CORD INJURY PATIENTS USING ASIA DEFINITION AND MODIFIED FRANKEL SCORE CLASSIFICATION

Serial neurological examinations were analysed on 94 consecutive spina l cord injury (SCI) patients admitted for rehabilitation to the Swiss Paraplegic Center at the Clinic Balgrist Zurich, Switzerland, between 1987 and 1992. Patients' data were examined adopting ASIA and modified Frankel definitions in order to compare the two classifications in te rms of consistency and prognostic value. The modified Frankel definiti on was subdivided into five categories (A, B, C, D and E). On admissio n (discharge) 43 (37) patients were classified as Frankel A, 23 (11) p atients in group B, 26 (42) patients in group C, 2 (2) patients as Fra nkel D and 0 (2) patients in group E. A qualitative analysis of the re sults on the base of a maximal score of 100 points (A = 0, B = 25, C = 50, D = 75 and E = 100 points) suggested a mean score improvement fro m 21.5 (+/-22.5) to 29.0 (+/-26.3) or 7.5 (+/-7.1), regarding all 94 p atients during follow up (admission/discharge). The median improvement was one modified Frankel grade (A/B to B/C). No detailed assessments were yielded concerning motor and sensory functions. Using ASIA defini tion, a continuous numerical score of motor and sensory function was o bserved. Recovery during follow up was determined by detailed motor an d sensory function. For all 94 patients (quadriplegics and tetraplegic s), the average motor recovery according to the ASIA definition was 9. 4 (+/-9.6). The mean ASIA motor score improved from 52.2 (+/-17.3) on admission to 61.6 (+/-17.9) on discharge. Light touch increased by 7.0 (+/-10.3) from 72.7 (+/-22.3) to 79.7 (+/-22.7) and pinprick sensory function by 7.1 (+/-13.6) from 69.2 (+/-21.8) to 76.3 (+/-22.2). Chang e in status was progressively unidirectional using both definitions. C omparing the ASIA guidelines with modified Frankel classification ther e was an unambiguous benefit using the new definition of ASIA, as a gr adual change of motor and/or sensory function was more clearly documen ted for all cases by ASIA. Using modified Frankel score definition, th e patient's classification may be unchanged, regardless of whether the status improved or remained stable. This was not the case using ASIA definition. It was not the intention in this paper to assess and compa re the treatment of acutely spinal cord injured patients by (a) nonope rative and (b) operative treatment.