The importance of the anal exam in neurologic classification of spinal cord injury

The anal exam, assessing sensation and sphincter contraction, is vital in the International Standards for Neurologic Classification of Spinal Cord Injury (ISNCSCI). Its importance has been debated, with contrasting viewpoints. Previnaire highlights the Bulbocavernosus Reflex (BCR) for insights into the sacral reflex arc, crucial for pelvic organ function prognosis in acute spinal cord injury. The anal wink and anobulbar reflexes provide similar information. Marino focuses on the rectal exam's role in ISNCSCI and motor function recovery, noting its potential unreliability, especially with impaired cognition, which affects the accuracy of sensory and motor assessments.

• 1
  The ISNCSCI has undergone repeated modifications to improve accuracy and address difficulties in initial assessments, highlighting the complexity of neurological classification.
• 2
  The inclusion of the BCR is valuable for prognostication of bladder, bowel, and sexual function, indicating the status of the sacral reflex arc after spinal cord injury.
• 3
  Deep Anal Pressure (DAP) presence indicates sensory modality conduction past the injury zone, emphasizing consistent anal examination performance for AIS B classification.