Risk factors of AIS C incomplete cervical spinal cord injury for poor prognosis—The significance of anorectal evaluation

Osahiko Tsuji, Kota Suda, Takehiro Michikawa, Masahiko Takahata, Masahiro Ozaki, Tsunehiko Konomi, Satoko Matsumoto Harmon, Miki Komatsu, Chikara Ushiku, Yusuke Menjo, Seiji Iimoto, Kota Watanabe, Masaya Nakamura, Morio Matsumoto, Akio Minami, Norimasa Iwasaki

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: Although the prognosis of incomplete cervical spinal cord injury (SCI) diagnosed as American Spinal Injury Association Impairment Scale grade C (AIS C) is generally favorable, some patients remain non-ambulatory. The present study explored the clinical factors associated with the non-ambulatory state of AIS C patients. Methods: This study was a single-center retrospective observational study. Seventy-three participants with AIS C on admission were enrolled and divided into two groups according to ambulatory ability after one year. Prognostic factors of SCI were compared in ambulatory (A-group) and non-ambulatory participants (NA-group). Univariable and multivariable logistic regression analyses were performed on demographic information, medical history, mechanism of injury, presence of fracture, ASIA motor scores (MS) of the extremities, neurological findings, including an anorectal examination on admission, and imaging findings. Results: Forty-one patients were included in the A-group and 32 in the NA-group. Univariable analysis revealed that the following factors were related to poor outcomes (p < 0.05): older age, history of cerebrovascular disorder, impairment/absence of S4-5 sensory score, deep anal pressure (DAP) (−), voluntary anal contraction (VAC) (−), anorectal tone (−), anal wink reflex (−), and low MS of the upper and lower extremities. In the multivariable analysis using age, presence or absence of sacral abnormality, and history of cerebrovascular disorders (adjusted for these three factors), older age and presence of sacral abnormality on admission were independent risk factors for a non-ambulatory state at the 1-year follow-up. Conclusions: Incomplete AIS C SCI individuals with older age and/or impairment of anorectal examination could remain non-ambulatory at 1-year follow-up.

Original languageEnglish
Pages (from-to)1227-1233
Number of pages7
JournalJournal of Orthopaedic Science
Issue number6
Publication statusPublished - 2023 Nov


  • AIS C
  • Motor incomplete injury
  • Prognosis
  • Spinal cord injury

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


Dive into the research topics of 'Risk factors of AIS C incomplete cervical spinal cord injury for poor prognosis—The significance of anorectal evaluation'. Together they form a unique fingerprint.

Cite this