Dr. Ebraheim’s educational animated video describes the sacral sparing test for spinal cord injury.
Sacral sparing tests can be used to indicate the presence of an incomplete spinal cord injury.
With a complete spinal cord injury, the patient will develop complete motor and sensory loss below the level of injury (ASIA A). no sacral sparing. The bulbocavernosus reflex will be present, which means the patient is not in spinal shock. After the spinal shock disappears as evidenced by the return of the bulbocavernosus, the patient with apparent complete spinal cord injury must be examined carefully for evidence of sacral sparing.
How do you do the bulbocavernosus reflex?
With a finger placed into the rectum, pull on the glans penis or the Foley catheter and check to see if there is a reflex response with the finger in the rectum.
The anal sphincter will not contract when the reflex is absent.
The anal sphincter will contract if the reflex is present.
The presence of any sacral sparing indicated an incomplete spinal cord injury.
Sacral sparing can be sensory, reflex or motor.
Sacral sparing can be evaluated through these tests of great toe flexor activity, rectal motor function, and perianal sensation. The best one of them is sensation around the anal region. If the patient maintains sensation around the anal region, this is known as sacral sparing.
Sensory:
•S1 lateral heal
•S2 popliteal fossa
•S3 ischial tuberosity
•S4-S5 perianal/genital area.
We are interested in the area of S4/S5 perianal sensation because basically the patient will not have any motor or sensory below the level of the lesion (check for sensation around the perianal area).
Sacral sparing indicates a favorable prognosis for recovery. Why?
The spinothalamic tract is near the lateral corticospinal tract and preservation of the pin prick sensation will predict recovery of some of the motor function.
Sacral sparing really does separate completely from incomplete injury of the spinal cord. If the patient does have sacral sparing, this is considered to be ASIA B. In ASIA B, the patient’s injury is incomplete, which means there is no motor function below the level of the lesion. However in ASIA B, there is a sensory function that is preserved below the level of the lesion including S4-S5.
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