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Kerry Campagnola


It looks like they changed the guidelines for documenting zone of partial preservation in 2019. (https://asia-spinalinjury.org/isncsci-2019-revision-released) You would document ZPP for incomplete injuries that have absent DAP vs documenting ZPP for complete injuries ONLY as indicated in the SCI module. Can you confirm that I am interpreting this correctly?

“ZPPs were only defined for complete (ASIA Impairment Scale (AIS) A) injuries with no sensorimotor function in the most caudal sacral segments. Recording ZPPs only in cases with totally lost sensation (absent deep anal pressure (DAP), absent light touch (LT), absent pin prick (PP)) in S4-5 and lost sacral motor function (no voluntary anal contraction (VAC)) is not intuitive and restricts the value of ZPP for effective clinical communication to AIS A lesions only. Therefore, the ZPP rules were modified and are no longer based on the AIS grade. Motor ZPPs are now defined and should be documented in all cases including patients with incomplete injuries with absent VAC. The sensory ZPP on a given side is defined in the absence of sensory function in S4-5 (LT, PP) on this side as long as DAP is not present. This means that in cases with present DAP, sensory ZPPs on both sides are not defined and should be noted as “not applicable (NA)”. In cases with absent DAP, a sensory ZPP can be defined on one side (assuming also absent LT and PP sensation in S4-5 on this side), while it may not necessarily be applicable (and should be noted as ‘NA’) on the other side if there is present LT or PP at S4-5.”