Original Article
Spinal Cord (2009) 47, 122–127; doi:10.1038/sc.2008.87; published online 29 July 2008
Assessment of the sympathetic level of lesion in patients with spinal cord injury
J G Previnaire1, J M Soler2, W El Masri3 and P Denys4
- 1Spinal Department, Centre Calvé, Fondation Hopale, Berck sur Mer, France
- 2Laboratoire d'urodynamique et de sexologie, Centre Bouffard Vercelli, Cerbère, France
- 3Midlands Centre for Spinal Injuries, RJ and AH Orthopaedic Hospital, Shropshire, UK
- 4Service de Rééducation Neurologique, Hôpital Raymond Poincaré, Garches, France
Correspondence: Dr JG Previnaire, Spinal Department, Centre Calvé, Fondation Hopale, 62600 Berck sur mer, France. E-mail: previnjg@hopale.com
Received 14 March 2008; Revised 19 June 2008; Accepted 22 June 2008; Published online 29 July 2008.
Abstract
Study design:
To study the vasomotor responses (skin axon-reflex vasodilatation (SkARV) to stimulation of the skin in spinal cord injury (SCI) patients.
Objective:
To assess the completeness of the sympathetic injury and to define the sympathetic level of lesion in paraplegic and tetraplegic patients.
Setting:
Centre Calve, Fondation Hopale and Centre Bouffard-Vercelli, France.
Subjects:
A total of 81 SCI patients ranging from C2 to L2.
Method:
A mechanical stimulation was applied to the skin on both sides of the trunk, using a blunt instrument. The presence of an abnormal response below the lesion helped define the sympathetic level.
Results:
Above the lesion, SkARV was observed in all patients. In patients with a complete sympathetic injury, the response below the lesion was either a vasoconstrictor response in upper motor neuron lesions, or total absence of SkARV in lower motor neuron lesions. There was excellent correspondence between complete somatic (American Spinal Injury Association (ASIA) A) and complete sympathetic lesions (100% of paraplegic and 94% of tetraplegic patients), whereas an incomplete somatic (ASIA B–D) lesion was often associated with a complete sympathetic lesion. In 34% of complete ASIA A patients, a sympathetic zone of partial preservation was found, extending below the lesion on sensory denervated dermatomes.
Conclusion:
SkARV is a simple bedside test that allows the assessment of sympathetic completeness of injury across the lesion as well as the excitability of the isolated spinal cord. We suggest that the definition of sympathetic level should be part of the classification of complete thoracic SCI.
Keywords:
axon-reflex vasodilatation, spinal cord injury, autonomic nervous system
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