Turkish Journal of Physical Medicine and Rehabilitation 2012 , Vol 58 , Num 1

Neurological Level in Spinal Cord Injury: Comparison Between ASIA Standards and Transcranial Magnetic Stimulatio

Halil Ünalan 1 ,Nurettin İrem Örnek 1 ,Nurten Uzun 2 ,Meral Erdemir Kızıltan 2 ,Ayşegül Gündüz 2 ,Murat Uludağ 1
1 İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, İstanbul, Türkiye
2 İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi, Nöroloji Anabilim Dalı, İstanbul, Türkiye
DOI : 10.4274/tftr.65982

Objective: The aim of the present study was to compare the findings of neurological examination performed according to the American Spinal Injury Association (ASIA) Standards with Motor Evoked Potentials (MEPs) obtained from paravertebral muscles of complete traumatic spinal cord injured (SCI) patients by using Transcranial Magnetic Stimulation (TMS).


Metarials and Methods: Twenty patients with complete traumatic spinal cord injury (C8-T12) who were examined and classified according to the ASIA standarts by the same physiatrist were included in the study. TMS applications were performed and evaluated by the same neurologist who was blind to the detailed neurological examination findings according to the ASIA standards.


Results: There was a significant difference (p<0.001) between the neurological levels and the most caudal paravertebral MEP levels found by TMS. In 19 of our 20 patients, the neurological levels were between T2-L1 segments and in almost all the patients, the sensory levels were considered as motor levels. This rule of ASIA standards might also play a role in these findings.


Conclusion: Results of the present study showed a significant difference (p<0.001) between the neurological levels determined by neurological examination and the most caudal paravertebral MEP levels found by transcranial magnetic stimulation. Considering the previous studies, we think that possible reasons for these findings include multisegmental innervation of the paravertebral muscles and the long muscle fiber conduction. The findings of the present study may contribute to the current literature, especially regarding the routine electrophysiological studies in patients with SCI.

Keywords : Spinal cord injury; transcranial magnetic stimulation; motor-evokedpotential; paravertebral muscles