ASIA-A Patients With Partial Preservation Versus Partial Recovery Dynamic Grading

Objective: To prospectively investigate changes in the zone of partial preservation (ZPP) and outside the extent of these zones in patients with complete [American Spinal Injury Association (ASIA-A)] spinal cord injury. Methods: Patients were examined and evaluated according to the ASIA revised 2000 criteria. Main outcome measure was the determination of partially innervated zones on early and late stages; we also examined sensory and motor recovery, neurologic level of injury, and ASIA classification. All the examinations were performed at admission to the rehabilitation unit and at months 6 and 12. Results: A total of 27 patients with ASIA-A complete spinal cord injury were included in the study. Fifteen patients completed the study. In 10 of 15 patients, zones that could not in the beginning be considered as ZPP according to the definition in ASIA 2000 Standards booklet turned out to be complete and/or partially recovered zones (sensory and/or motor-though not functional in most of the cases) in the follow-up period. Conclusions: Lately recovered zones that terminologically cannot be considered as ZPP on initial examinations (according to ASIA standards) may be called as "zone of partial recovery" at some time after the injury. The term ZPP may be used during a limited time period to be clearly distinguished from zones that were not preserved but recovered neurologically. In other words: "When 'zone of partial preservation'?' and "When 'zone of partial recovery'?"