A Comparison of Level of the Injury, Sacral Cord Sign and Urodynamic Testing in the Evaluation of the Patients with Spinal Cord Injury

Jeon, Byoung Kyu; Lee, Jeong Gu

Abstract

To define if the signs of sacral cord involvement have any predictive values in the behavior of bladder and sphincter function after spinal cord injury, we analysed results of neurologic signs and urodynamic studies from 45 patients with spinal cord injuries. Patients were classified based on the anatomical level (suprasacral vs. infrasacral), and the presence or absence of sacral cord sign (SCS) (bulbocavemous reflex latency time, perineal sense, anal sphincter tone). Urodynamic findings were classified as either detrusor hyperreflexia (DH), detrusor sphincter dyssynergia (DSD), detrusor areflexia (DA) or normal. Results were as follows; 1) Of the 15 suprasacral cord lesioned patients 6 (40%) had DA, of the 30 infrasacral cord lesioned patients 9 (20%) had either DA or DH with DSD. 2) SCS was positive in 16 out of 30 infrasacral, and in 3 out of 15 suprasacral cord lesioned patients. Of the 26 SCS negative patients, suprasacral cord lesioned patients comprised 46%. 3) Of the 30 infrasacral lesioned patients, 21 had DA and 16 had positive SCS. Incidence of positive SCS in the patients with DA was 72%. 4) Incidence of negative SCS with DH or DH+DSD was 100% in suprasacral lesion. But of the 15 suprasacral lesioned patients, 6 had DA and 3 had positive SCS. 5) In all levels of the injury, positive predictive value for the DA in positive SCS was 95%. However, negative predictive value for DA or DA+DSD in negative SCS was only 62%. These results indicate that there were poor correlation between the level of the cord injury and types of urodynamic abnormalities. Also, the correlation of the SCS with anatomical level of the injury was relatively poor. Correlation of the Positive SCS with DA was very significant for both levels of the cord injury; whereas there were poor correlation of the negative SCS with DH or DH+DSD. In conclusion, the positive SCS in itself are thought to be valuable tool in predicting infrasacral lesion and/or detrusor areflexia However, the results of negative SCS may not exclude infrasacral lesion or detrusor areflexia completely. Thus, combination of the sacral cord sign and results of urodynamic evaluation will provide a more precise diagnosis and treatment plan for the patients of spinal cord lesions.