Question 29

College answer

Whilst most candidates scored reasonably well in this question, many candidates answered the question with a to narrow a focus on the neurological findings, rather than the broader features e.g. prognosis/other organ dysfunctions/interventions when asked to compare and contrast. This aspect of the question was which was worth 60% of the marks

Discussion

To defend the trainees, "features" here would immediately make the stressed exam candidate think of "clinical features", especially as the stem goes on to mention a "neurological level". Most reasonable people would agree that it would have been fairer to explicitly ask for "prognosis/other organ dysfunctions/interventions" if this is what was expected.

The definitions below come from the 2019 revision of the ASIA classification statement

a)

Complete spinal cord injury:  an absence of any sensory and motor function in the lowest sacral segments (light touch, pin prick at S4-5, DAP, and voluntary anal contraction) (i.e., no “sacral sparing”).

Neurological level of injury: the most caudal segment of the spinal cord with normal sensory and antigravity motor function on both sides of the body, provided that there is normal (intact) sensory and motor function rostrally.

b) Four incomplete syndromes: only four are asked for, but there are in fact five listed by ASIA, and probably more that are theoretically possible.

1. Central cord syndrome
2. Brown-Séquard syndrome
3. Anterior cord syndrome
4. Posterior cord syndrome
5. Cauda equina syndrome
6. Conus medullaris syndrome

c) To contrast "the features of a complete SCI and central cord syndrome at neurological level of C4" would benefit from a table format: