The revised zone of partial preservation (ZPP) in the 2019 International Standards for Neurological Classification of Spinal Cord Injury: ZPP applicability in incomplete injuries
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Published:2024-01-08
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ISSN:1362-4393
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Container-title:Spinal Cord
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language:en
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Short-container-title:Spinal Cord
Author:
Schuld ChristianORCID, Abel Rainer, Curt Armin, Kalke Yorck-Bernhard, Kriz Jiri, Maier Doris, Weidner Norbert, Kirshblum StevenORCID, Tansey KeithORCID, Betz Randal, Biering-Sørensen Fin, Burns Stephen P., Donovan William, Graves Daniel E., Guest James, Jones Linda, Krassioukov Andrej, Mulcahey Mary Jane, Read Mary Schmidt, Rodriguez Gianna M., Walden Kristen, Rupp RüdigerORCID, ,
Abstract
Abstract
Study design
Consensus process.
Objectives
To provide a reference for the Zone(s) of Partial Preservation (ZPP) in the 2019 International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and analyze the initial impact of applicability of the revised ZPPs. Revisions include the use of ZPPs in selected incomplete injuries (in addition to prior use in sensorimotor complete injuries). Specifically, the revised motor ZPPs are applicable bilaterally in injuries with absent voluntary anal contraction (VAC) and the revised sensory ZPP for a given side is applicable if deep anal pressure (DAP), light touch and pin prick sensation in S4-5 are absent on that side.
Setting
Committee with 16 ISNCSCI experts and datasets from the European Multicenter Study about Spinal Cord Injury (EMSCI).
Methods
Occurrence frequencies of applicable ZPPs were determined in an EMSCI cohort consisting of two ISNCSCI examinations from 665 individuals with traumatic SCI.
Results
Motor ZPPs were derived in 35.2% of all datasets of incomplete injuries, while sensory ZPPs are much less frequent (1.0%). Motor ZPPs are applicable in all American Spinal Injury Association Impairment Scale (AIS) B datasets (mean ZPP length: 0.9 ± 1.0 segments), in 55.4% of all AIS C datasets (ZPP length: 11.8 ± 8.2 segments) and in 9.9% of the AIS D datasets (ZPP length: 15.4 ± 7.9 segments).
Conclusions
The revised ZPP allows for determining motor ZPPs in approximately 1/3 of all incomplete injuries. The broadened applicability enables the use of ZPPs beyond complete injuries for complementary description of residual functions in more individuals.
Sponsorship
N/A
Publisher
Springer Science and Business Media LLC
Subject
Neurology (clinical),Neurology,General Medicine
Reference20 articles.
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