DIAGNOSIS OF TRAUMATIC SPINAL CORD INJURIES (SCI): INITIAL CLINICAL EVALUATION AND SYSTEMATIC NEUROLOGICAL EXAMINATION

Abstract

Spinal cord injury (SCI) is a high-impact neurological injury that results in permanent functional deficits and significant limitations in quality of life. A coordinated initial approach, starting with pre-hospital immobilization, is crucial. Diagnosis and prognostic stratification are fundamentally based on the application of the Systematized Neurological Examination, according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) or the American Spinal Injury Association (ASIA) scale. This protocol classifies injuries as complete (AIS A) and incomplete (AIS B to E), with incomplete injuries (especially C and D) associated with a greater potential for motor recovery in the first three to six months. The evaluation is complemented by neuroimaging, with computed tomography (CT) for bone assessment and magnetic resonance imaging (MRI) indispensable for the spinal cord parenchyma. Current clinical evidence strongly favors early surgical decompression (within 24 hours) to mitigate secondary damage. Adjuvant and regenerative therapies (such as riluzole and mesenchymal stem cells) are under investigation, and early rehabilitation, with the aid of technologies such as functional electrical stimulation (FES), is essential to optimize functional recovery and neuroplasticity. It is concluded that a systematic clinical assessment, integrated with neuroimaging, is the central pillar for therapeutic decision-making and optimization of prognosis in spinal cord injury (SCI).