Sensory anal examination in spinal cord injury

Article (PDF Available)inSpinal Cord 47(12):901 · July 2009with18 Reads
DOI: 10.1038/sc.2009.85 · Source: PubMed
Spinal Cord is the official journal of the International Spinal Cord Society. It provides complete coverage of all aspects of spinal injury and disease.
Sensory anal examination in spinal cord injury
Spinal Cord (2009) 47, 901; doi:10.1038/sc.2009.85;
published online 30 June 2009
I enjoyed reading the paper by Krogh et al.
I would
recommend the addition of sensory anal examination to
their physical examination. This would involve superficial
anal examination with cotton and pinprick and asking about
the amount of sense perceived on both the right and left
sides. Comparison between both sides and with areas of
normality is recommended. Observation of anal wink
during sensory examination is a helpful test to see the
tone of the anus. For example, if the examiner asks the
patient to contract the anal sphincter and the patient
answers that he/she cannot do so, but an anal wink is seen
during the pinprick stimulation, it shows that tone is
present. The bulbocavernous reflex and observation of the
anus during a gentle pinch of glans penis should also be
Acknowledgemen ts
I thank Professor Alexander R Vaccaro for his edit of the
V Rahimi-Movaghar
Sina Trauma and Surgery Research Center, Sina Hospital,
Tehran University of Medical Sciences, Tehran, Iran
E-mails: and
1 Krogh K, Perkash I, Stiens SA, Biering-Sorensen F. International
bowel function extended spinal cord injury data set. Spinal Cord
2009; 47: 235–241.
Re: Case report: A fatal metastasis of Klebsiella pneumonia
to the lungs
Spinal Cord (2009) 47, 901902; doi:10.1038/sc.2009.96;
published online 28 July 2009
Dr Frisbie presents a case of a 61-year-old tetraplegic who
developed a respiratory tract infection with Klebsiella
pneumonia, which he suggests migrated to the lungs and
caused an overwhelming infection from which the patient
died. He suggests that the origin of pulmonary infections can
be extra-pulmonary.
There is a very rich literature on the subject, which I feel
should be acknowledged in such a presentation.
Charcot in 1877 showed that pressure sores became
infected and caused septic emboli in the lungs.
‘We shall also notice gangrenous emboli. In this
variety, thrombi impregnated with gangrenous ichor
are transported to a distance and give rise to gang-
renous metastases, which are principally observed in
the lungs. This is a point upon which Dr Ball and
myself have insisted in a work published in 1857.
long before us, and even long before the theory of
embolism had been Germanised, M Foville had
expressed his opinion that a considerable number of
cases of pulmonary gangrene, observed in the insane,
and in different diseases of the nervous centres, are
caused by the transport into the lungs of a part of the
fluid which bathes the eschars of the breech’.
Wagner who set up a dedicated spinal unit also described
the systemic effect of pressure sores.
‘Prior to the opening of centres for the treatment of
paraplegic patients, the majority died soon after injury from
the effects of renal sepsis. In 1917 Thompson Walker found
that 47.2% of the patients admitted with spinal injuries to
the King George V military Hospital died from urinary
infection 8 to 10 weeks after admission. With the advent
of specialised centres during the 1939–45 war, this early
mortality was reduced largely due to the better under-
standing of the management of the paralysed bladder,
regular turning and the availability of antibiotic therapy
and blood transfusions. If the patient survived the dangerous
six weeks immediately after injury they still were liable to die
from the long-term complications of low grade infection of
Spinal Cord
(2009) 47, 901 902
2009 International Spinal Cord Society All rights reserved 1362-4393/09
  • [Show abstract] [Hide abstract] ABSTRACT: Spinal Cord is the official journal of the International Spinal Cord Society. It provides complete coverage of all aspects of spinal injury and disease.
    Full-text · Article · Jan 2012
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Spinal cord injury [SCI] occurring in military veterans is a disabling and highly morbid event. Often the victims are young active males who sustain these injuries during military conflict and suffer from the complications of the SCI for the rest of their lives. Objectives: The aim of the study is to report the epidemiology of Iranian SCI veterans and their health related quality of life, medical complications and patient associated outcomes. Material and methods: A cohort of 1984 patients was examined to investigate the epidemiology of Iranian SCI veterans of the Iraq-Iran War (1980-1988); 1803 out of the total number of SCI records were included. Health monitoring was carried out through scheduled monthly visits by general physicians, followed by interviews with specialists from March 20, 2007, to March 19, 2010. Additional follow-up was conducted by telephone survey. Results: In all, 174 patients (8.77%) had incomplete injury and the rest had complete injury. the most frequent level of injury was the thoracic level (1256 patients - 63.30%). Pressure ulcers were the most frequent complication (up to 14.7% annual prevalence), followed by reactions to severe stress and adjustment disorders (up to 13.6%) and diabetes (up to 10.1%). In the telephone surveys, kidney and/or urologic disorders were the most frequent reported complaints (21.6%). A total of 101 out of the 1984 SCI veterans died between 2000 and 2010 (~0.5% per year). Conclusions: In veterans with spinal cord injury, pressure area ulcers (ICD10:L89), reactions to severe stress and adjustment disorders (ICD10:F43), diabetes mellitus (ICD10:E10-E14) and kidney and/or urologic disorders are common and should be addressed aggressively in healthcare planning and management programs for patients with spinal cord injuries.
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