A patient's ASIA exam reveals no VAC, absent DAP, and 0/2 scores for S4-S5 light touch/pinprick. All other criteria suggest completeness. What AIS grade is assigned?

A patient's ASIA exam reveals no VAC, absent DAP, and 0/2 scores for S4-S5 light touch/pinprick. All other criteria suggest completeness. What AIS grade is assigned?

• A. AIS A
• B. AIS B
• C. AIS C
• D. AIS E

Answer: (D)

The key idea is that AIS grading depends on what function remains below the level of injury, including the sacral segments S4–S5. A fully complete injury shows no motor or sensory function below the neurological level, and sacral function is absent. Here, there is no voluntary anal contraction and no deep anal pressure, plus 0/2 sensation at S4–S5. That means there is no sacral sensory or reflex function and no preserved function below the injury. With no motor or sensory preservation below the level, the injury is classified as AIS A (complete). AIS E would require normal, intact motor and sensory function, which is not the case here. In contrast, if there were any preserved sensation or motor function below the injury, or sacral sparing, the grade would be incomplete (B, C, or D depending on the level and amount of preserved motor function).

The key idea is that AIS grading depends on what function remains below the level of injury, including the sacral segments S4–S5. A fully complete injury shows no motor or sensory function below the neurological level, and sacral function is absent.

Here, there is no voluntary anal contraction and no deep anal pressure, plus 0/2 sensation at S4–S5. That means there is no sacral sensory or reflex function and no preserved function below the injury. With no motor or sensory preservation below the level, the injury is classified as AIS A (complete). AIS E would require normal, intact motor and sensory function, which is not the case here.

In contrast, if there were any preserved sensation or motor function below the injury, or sacral sparing, the grade would be incomplete (B, C, or D depending on the level and amount of preserved motor function).