Which is the role of the ASIA impairment scale in the evaluation of cauda equina and conus medullaris syndromes?

Updated: Jun 14, 2018
  • Author: Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Answer

In defining impairments associated with a spinal cord lesion, the American Spinal Cord Injury Association (ASIA) impairment scale is used in determining the level and extent of injury.

This scale should also be used in defining the extent of conus medullaris syndrome/cauda equina syndrome. The scale is as follows:

  • A - Complete; no sensory or motor function preserved in sacral segments S4-S5

  • B - Incomplete; sensory, but not motor, function preserved below the neurologic level and extends through sacral segments S4-S5

  • C - Incomplete; motor function preserved below the neurologic level, and the majority of key muscles below the neurologic level have a muscle grade less than 3

  • D - Incomplete; motor function preserved below the neurologic level, and the majority of key muscles below the neurologic level have a muscle grade greater than or equal to 3

  • E - Normal; sensory and motor function normal

The injury should be described using this scale, for example, ASIA class A. Most patients with cauda equina/conus medullaris syndrome are in ASIA class A or B initially and gradually improve to class C, D, or E.


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