The International Standards for Neurological Classification of Spinal Cord Injury: Classification Accuracy and Challenges

The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is the standard for characterizing sensorimotor impairments after spinal cord injury (SCI). Achieving accuracy in both the ISNCSCI examination and classification is essential. The 2019 ISNCSCI update introduced documentation of non-SCI conditions and a revised definition of the Zone of Partial Preservation (ZPP). This study evaluates the classification accuracy of SCI professionals using the 2019 ISNCSCI edition. An online survey with six ISNCSCI cases was completed by 107 members of the International Spinal Cord Society (ISCoS) and attendees of the ISCoS Annual Scientific Meeting 2021 to evaluate classification accuracy and identify common mistakes.

• 1
  Overall classification accuracy was 74.6%. Accuracy was highest for injury completeness (95.3%) and sensory level (91.1%), but lower for motor zone of partial preservation (ZPP; 54.7%) and ASIA Impairment Scale (AIS) grade (57.3%).
• 2
  Knowledge deficits about the 2019 ISNCSCI updates are prevalent and contribute to common classification errors, especially in newer concepts, including the appropriate documentation of non-SCI conditions and classification of ZPP in incomplete injuries.
• 3
  There was a significant association between overall classification accuracy and self-rated experience in the ISNCSCI classification (p = .017).