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The paper by Iseli et al 1 (this issue, pp 567–71) reflects the current interest in diagnostic techniques which could supplement the neurological examination in diagnosing a spinal cord injury, monitoring recovery, and predicting the final outcome.
A detailed neurological examination is still the most accurate assessment tool and the best predictor of the final outcome in patients with spinal cord injury.2 3 The American Spinal Injury Association (ASIA) protocol with its motor and sensory scores is the standardised instrument of this sort, internationally accepted and widely used.4 Over the past few years there has been an increased interest in developing additional and more objective instruments for assessing the level and severity of the spinal cord lesion. Curt and Dietz, coauthors of this issue’s article, have published several interesting papers examining the relevance of somatosensory evoked potentials, motor evoked potentials, and ASIA motor and sensory scores in predicting the functional outcome in patients with spinal cord injury. The same authors gave a very compehensive scientific review of electrophysiological recordings and their predictive value in patients with SCI.5
The originality of this issue’s paper is that in it the authors are comparing two groups of patients with different aetiology and pathophysiology of the lesion, one ischaemic and the other traumatic. Using ASIA clinical protocol, tibial and pudendal somatosensory evoked potentials (SSEPs), and ambulation capacity they compare the degree of neurological and functional recovery between the two patient groups. Using multiple regression analysis they try to determine the best prognostic factors for the functional recovery for each of the groups.
The results show many similarities between the groups. The authors suggest that the few differences may be due to different underlying pathophysiological mechanisms. Finally, they offer the best predictor of the functional outcome (measured as the ambulation capacity), which is the combination of the motor score and tibial SSEPs in both patient groups.