Clinical Sciences/Health Conditions
Natan Bensoussan, MD, MSc candidate
Physiatrist
Université de Montréal / Hôpital du Sacré-Cœur de Montréal
Montreal, Quebec, Canada
Ariane LeBlanc Grant, BA
Medical student and MSc candidate
Université de Montréal
Montreal, Quebec, Canada
Jean-Marc Mac-Thiong, MD, PhD
Orthopedic Surgeon, Principal Investigator
Université de Montréal / Hôpital du Sacré-Cœur de Montréal / Centre Hospitalier Universitaire Sainte-Justine
Montreal, Quebec, Canada
Juan David Cifuentes Hernandez, MD
Clinical Fellow
Hôpital du Sacré-Coeur de Montréal (Quebec, Canada) / Unidad de Medicina Física y Rehabilitación, Clínica Las Américas (Medellin, Colombia) / Grupo de Rehabilitación en Salud, Universidad de Antioquia (Medellin, Colombia)
Montreal, Quebec, Canada
Andréane Richard-Denis, MD, MSc
Physiatrist, Principal Investigator
Université de Montréal / Hôpital du Sacré-Cœur de Montréal / Centre de recherche interdisciplinaire en réadaptation du Montreal métropolitain
Montreal, Quebec, Canada
Neurogenic bladder and bowel dysfunction (NBBD) is a common complication of spinal cord injury and cauda equina syndrome (SCI+). Timely identification is essential for appropriate specialized rehabilitation triage, limited and resource-intensive. Current bedside assessment relies on a manual rectal examination, an often unreliable measure, particularly in motor-incomplete SCI+. We developed and validated the ElectroSacroGram (ESG), a non-invasive surface electromyography tool, providing quantitative assessment. This study aimed to identify predictive ESG parameters and develop a threshold-based algorithm to guide early postoperative specialized rehabilitation triage.
Design:
This prospective observational study included 103 patients with acute motor-incomplete SCI+ in a specialized trauma center from March 2024 to September 2025. The ESG was performed within the first postoperative week to assess at bedside the resting anal tone, voluntary anal contraction (VAC) (deltaVAC= maximal VAC - anal tone), bulbocavernosus reflex (µV), and sacral sensation via the electrical perceptual thresold (EPT, mA). The need for specialized sphincter rehabilitation was determined at discharge or day 15, based on consensus among SCI specialists considering trial of void (TOV) and ISAFSCI data. Mann-Whitney U Tests compared ESG parameters. A classification and regression tree (CART) generated a triage algorithm and its predictive performance was evaluated with receiver operating characteristic curves.
Results:
Among 103 patients, 39 (37.9%) required specialized sphincter rehabilitation and 64 (62.1%) did not. DeltaVAC and EPT values differed significantly between groups (5.2 µV vs. 12.6 µV (p < .001); 6.5 mA vs. 11mA (p < .001). With these parameters, CART model using thresholds of 9.3 µV and 15 mA achieved sensitivity of 92.3% and specificity of 82.8%, accurately identifying 89.3% of patients requiring specialized sphincter rehabilitation.
Conclusion:
The ESG is a simple bedside neurophysiological tool providing the first quantitative measures of neuro-sacral function in acute SCI+. ESG-based triage can improve early rehabilitation orientation and support personnalized care.
