Motor levels in high cervical spinal cord injuries: Implications for the International Standards for Neurological Classification of Spinal Cord Injury

This study investigates how clinicians determine motor levels (ML) in patients with high cervical spinal cord injuries (SCI) using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). The ISNCSCI is a tool used to assess the severity and location of SCI. The researchers hypothesized that determining MLs based on sensory levels in the upper cervical segments (C2-C4) can be misleading when the C5 and C6 myotomes (muscle groups) are intact. This means that if a patient has sensation at C2 but intact muscle function at C5 and C6, it might be counterintuitive to classify the motor level as C2. The study involved clinicians classifying two variations of a high cervical SCI case. In one variant, C5 and C6 myotomes were intact, while in the other, they were weakened. The results showed that clinicians were more likely to misclassify the motor level when C5 and C6 were intact, suggesting that the current ISNCSCI guidelines may need adjustment.

• 1
  Clinicians misclassified the motor level in variant 1 (intact C5/C6 myotomes) more frequently (33.15%) compared to variant 2 (2.17%), where C5/C6 myotomes were not intact.
• 2
  The study demonstrated that sensory level inferred motor levels in the C2-C4 region are counterintuitive when C5 and C6 myotomes are intact.
• 3
  The findings suggest that the 'motor follows sensory' rule in ISNCSCI may need adjustment to better reflect clinical intuition and functional capabilities of patients with high cervical SCI.