Light touch and pin prick disparity in the International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI)

Abstract

Study design: Retrospective review. Objectives: The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) assesses cutaneous sensibility through light touch (LT) and sharp-dull discrimination, referred to as pin prick (PP). This project aimed to confirm a tendency for LT to score higher than PP in SCI subjects and discuss possible reasons for such disparity. Setting: Single site cohort study, the London Spinal Cord Injury Centre, United Kingdom. Methods: A retrospective analysis of LT and PP scores of 99 spinal cord injury subjects at the time of discharge (median 5 months) from acute care and rehabilitation in the London Spinal Cord Injury Centre was conducted. Subjects were aged 10-88 years (median 44 years; 78 men, 74 traumatic, 25 non-traumatic). There were 40 American Spinal Injury Association (ASIA) Impairment Scale (AIS) A, 7 B, 18 C and 34 D subjects. Results: A disparity (Po0.001) was found between LT (64.5 ± 3.2, mean ± s.e.) and PP (54.7 ± 2.9) AIS sensory scores. A similar difference in score (LT4PP) was registered both for traumatic and non-traumatic injury, but was greater for incomplete than for complete injury. Despite the difference, LT was well correlated with PP (R ¼ 0.87, Po0.001). Spinal segmental level of injury was determined more frequently by PP alone (43 of 99) than by LT (10 of 99) alone. Conclusion: The discrepancies between LT and PP could relate to the greater complexity of the PP test or a difference in the extent of injury to the posterior columns (LT) and spinothalamic (PP) tracts. Further interpretation would benefit from additional electrophysiological sensory tests.

Predicting the Risk for Central Pain Using the Sensory Components of the International Standards for Neurological Classification of Spinal Cord Injury

“…Interestingly, higher LT than PP scores were recently reported for a nonspecific cohort of SCI patients, irrespective of the type of injury and the neurological level. 41 The authors attributed this imbalance to the complexity of PP versus LT examination, because the former involves sharp/blunt discrimination and also to a greater susceptibility of spinothalamic than dorsal column axons to damage during SCI. Other studies however, did not find evidence for such an imbalance, showing comparable damage to both the spinothalamic and dorsal column systems in CP.…”

Feasibility of using training cases from International Spinal Cord Injury Core Data Set for testing of International Standards for Neurological Classification of Spinal Cord Injury items

“…Despite this, it has to be emphasized that SL is determined on the basis of both PP and LT sensations. Although five case scenarios involved clinical reasoning about SL determination, only one scenario showed difference in level between PP and LT. From a retrospective review by Vasquez et al, 12 it is noticed that only in 30.3% instances LT and PP both indicated the same level of injury. Most frequently, PP alone determined the level.…”

Modified Postauricular Incision for Preservation of the Lesser Occipital Nerve and the Great Auricular Nerve in Ear Surgery

“…Kang et al [18] also used it to assess the auricular sensation and suggested that it can provide relatively objective and accurate information. The PP test was used to evaluate pain, and it is used in the studies of auricular numbness in parotid gland surgery [15,19,20]. Other sensations were not determined, such as two-point discrimination or temperature sensation.…”