The predictive value of plantar flexion of the toes in the assessment of neuropathic voiding disorders in patients with spine lesions at the thoracolumbar level

Objective: To correlate the presence of voluntary contraction of the planta r flexors of the toes with neuropathic voiding disorders in patients with s pinal cord injury (SCI) after thoracolumbar fracture. Subjects and Methods: Sixty-three SCI patients with thoracolumbar fractures were prospectively examined neurologically (American Spinal Cord Injury As sociation protocol) and urodynamically during their first hospitalization. To assess neurologic recovery, patients were reassessed after at least 1 ye ar. Bladder function was also reevaluated and correlated to neurologic eval uation performed on the same day. Settings: Primary care center, university facility. Results: There was a significant correlation between score of the plantar f lexors of the toes and the presence or absence of voluntary contraction of the external anal/urethral sphincter (p <.001). However, this was of no pre dictive value concerning neuropathic bladder type (p >.05). Seven patients recovered from their neuropathic voiding disorders. There was a significant correlation between the reappearance of a voluntary external anal/urethral sphincter contraction and bladder recovery (p <.01), but there was no sign ificant correlation between the score obtained for the plantar flexors of t he toes and the presence or absence of the bulbocavernosus reflex (p >.05). Conclusions: It appears that in SCI patients with thoracolumbar fractures, the presence of a voluntary contraction of the plantar flexors of the toes correlates with active contraction of the external anal/urethral sphincter but does not enable differentiation of the types of neuropathic voiding dis orders. Urodynamic examination remains mandatory for assessment of the func tional aspect of the neuropathic voiding disorders. (C) 1999 by the America n Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.