Acute spinal cord injury - Frankel Classification grading system

http://www.surgicalneurology.org/spine/

Complete neurological injury - no motor or sensory function clinically detected below the level of
Grade A
the injury.
Preserved sensation only - no motor function clinically detected below the level of the injury;
Grade B sensory function remains below the level of the injurybut may include only partial function (sacral
sparing qualifies as preserved sensation).
Preserved motor non-functional - some motor function observed below the level of the injury, but
Grade C
is of no practical use to the patient.
Preserved motor function - useful motor function below the level of the injury; patient can move
Grade D lower limbs and walk with or without aid, but does not have a normal gait or strength in all motor
groups.
Normal motor - no clinically detected abnormality in motor or sensory function with normal
Grade E
sphincter function; abnormal reflexes and subjective sensory abnormalities may be present.

http://www.surgicalneurology.org/spine/

Babaji

Spine scales
Compiled by:
G Narenthiran
BSc(MedSci) MB ChB MRCSE
g_narenthiran@hotmail.com
2007

| Frankel Classification | Nurick classification | Ranawat Classification | JOA scale | Chiles et al's
modified JOA scale | Benzel et al's modified JOA scale | ASIA score | McCormick classification |

Acute spinal cord injury - Frankel Classification grading system

Complete neurological injury - no motor or sensory function clinically detected below

Grade A
the level of the injury.
 Preserved sensation only - no motor function clinically detected below the level of
Grade B the injury; sensory function remains below the level of the injurybut may include only
partial function (sacral sparing qualifies as preserved sensation).

Preserved motor non-functional - some motor function observed below the level of
Grade C
the injury, but is of no practical use to the patient.

Preserved motor function - useful motor function below the level of the injury;
Grade D patient can move lower limbs and walk with or without aid, but does not have a
normal gait or strength in all motor groups.

Normal motor - no clinically detected abnormality in motor or sensory function with

Grade E normal sphincter function; abnormal reflexes and subjective sensory abnormalities
may be present.

Nurick's classification system for myelopathy on the basis of gait abnormalities

Grade Root signs Cord involvement Gait Employment

0 Yes No Normal Possible

I Yes Yes Normal Possible

II Yes Yes Mild abnormality Possible

Severe
III Yes Yes Impossible
abnormality

Only with
IV Yes Yes Impossible
assistance

Nurick S. The pathogenesis of spinal cord disorder associated with cervical spondylosis. Brain
1972; 95: 87-100

Ranawat Classification of Neurologic Deficit

Class I Pain, no neurologic deficit

Subjective weakness, hyperreflexia,

Class II
dyssthesias

Class III Objective weakness, long tract signs

Class IIIA Class III, ambulatory

Class IIIB Class III, nonambulatory

Ranawat CS, O'Leary P, Pellicci P, et al. Cervical fusion in rheumatoid arthritis. J Bone Joint
Surg Am 1979; 61: 1003-1010

The Japanese Orthopaedic Association scale: An objective assessment scale quantitating the
severity of the spondylotic myelopathy based on four categories:

Chiles et al's modified version of the Japanese Orthopaedic Association Scale:

Benzel et. al.'s modified Japanese Orthopaedic Association Scale

American Spinal Injury Association score:

cCormick functional classification of intramedullary spinal cord tumours (simplified)

Grad
Desciption
e

Neurologically
I normal, mild focal
deficits, normal gait

Sensorimotor
deficits affecting
II function, severe
pain, gait difficulties,
can still walk

III Moderate
neurological deficit,
reques cane for
 ambulation, +/-
arms affected, +/-
imdependent

As above + arms
IV affected, usually not
independent

Ref.: George Samandouras. The Neurosurgeon's Handbook. Oxford, 2010. p862

g_narenthiran@hotmail.com
 Global Spine J. 2011 Dec; 1(1): 18.
PMC full text: doi: 10.1055/s-0031-1296049
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Table 1
The Frankel Scale for Spinal Cord Injury That Classifies the Extent of the
Neurological/Functional Deficit into Five Grades10

Frankel Scale

A Complete No motor or sensory function below level of lesion

B Sensory only No motor function, but some sensation preserved below level of
lesion

C Motor useless Some motor function without practical application

D Motor useful Useful motor function below level of lesion

E Recovery Normal motor and sensory function, may have reflex abnormalities

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864437/table/TB00006-1/