Authors of section

Author

Carlo Bellabarba

General Editor

Luiz Vialle

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Patient examination: Neurological evaluation

1. Classification

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

2. Lumbo-sacral nerve root injury

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.
patient examination neurological evaluation

3. Motor function

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

patient examination neurological evaluation

Ankle dorsiflexors (L4)

patient examination neurological evaluation

Great toe extensors (L5)

patient examination neurological evaluation

Ankle plantar flexors (S1)

patient examination neurological evaluation

4. Sensory function

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).

patient examination neurological evaluation

5. Reflex examination

Achilles tendon (S1).

patient examination neurological evaluation

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

patient examination neurological evaluation

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

Clinical presentation:

  • Bowel and bladder dysfunction
  • motor deficits
patient examination neurological evaluation