Patient examination: Neurological evaluation

Neurological injuries at sacral level are classified as follows:

• Nx: Cannot be examined
• N0: No neurological deficits
• N1: Transient neurological injury
• N2: Nerve root injury
• N3: Incomplete Cauda Equina Syndrome

Before undertaking definitive treatment of sacral fractures, it is essential to know the functional status of the patient's lumbosacral nerve roots. A careful and detailed examination is necessary, to assess perineal sensation.

Neurologic abnormalities should be correlated with anatomic site of injury:

• If a lumbo-sacral nerve deficit is present in extra sacral injuries, further investigation and possible treatment must be considered.
• If a sacral nerve deficit is present with a sacral fracture, the nerves may need decompression with fracture reduction and/or sacral laminectomy.

There are six levels of muscle strength, ranging from 0 – 5, as indicated on the INSCI assessment sheet.

Ankle dorsiflexors (L4)

Great toe extensors (L5)

Ankle plantar flexors (S1)

Pin prick sensation is assessed with a needle. Light touch sensation is assessed with a piece of tissue paper.

Sensation is scored as absent (0), abnormal (1), or normal (2).

Achilles tendon (S1).

The S2-5 dermatomes should be assessed for pin prick and light touch sensation (diagram, dermatome).

In the Cauda Equina Syndrome there is an injury to the spinal rootlets

Clinical presentation:

• Bowel and bladder dysfunction
• motor deficits