• Laura Krisa, Devon Middleton, Scott Faro, Christina L Calhoun, Feroze B Mohamed, and M J Mulcahey.
• Shriners Hospitals for Children , Philadelphia, Pennsylvania.
• Top Spinal Cord Inj Rehabil. 2013 Jan 1; 19 (2): 121-8.

BackgroundThe International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) are internationally accepted to determine and classify the extent of motor and sensory impairment along with severity (ASIA Impairment Scale [AIS]) following spinal cord injury (SCI). The anorectal examination is a component of the ISNCSCI that determines injury severity. There is a void in the health care literature on the validity of the anorectal examination as an indication of SCI severity.ObjectiveTo validate the use of functional magnetic resonance imagining (fMRI) for the purpose of classifying the severity of SCI in children.MethodsSeventeen patients, with the average age of 14.3 years, underwent 1 complete ISNCSCI examination. Subjects also underwent the anorectal portion of this exam while fMRI data were collected using a 3.0 Tesla Siemens Verio Scanner. Cortical areas of activation were analyzed for possible differences of cortical involvement between complete (AIS A) and incomplete (AIS B, C, and D) SCI subjects. Anxiety/anticipation of the test was also assessed.ResultsThis study established an fMRI imaging protocol that captures the cortical locations and intensity of activation during the test of sacral sparing. In addition to developing the data acquisition protocol, we also established the postacquisition preprocessing and statistical analysis parameters using SPM8.ConclusionPreliminary findings indicate that fMRI is a useful tool in evaluating the validity of the anorectal examination in determining SCI severity. Assessment of which cortical regions are activated during the testing procedure provides an indication of which pathways are transmitting information to the brain.

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