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Final Program


Final Congress Guide

Clinical Sciences/Health Conditions

400 Section - Transforming neuro-sacral assessment in spinal cord injury: Development and validation of the ElectroSacroGram (ESG)

Tuesday, May 19, 2026
6:00 PM - 7:30 PM PT

    Presenting Author/Autor expositor(s)

  • NB

    Natan Bensoussan, MD, MSc candidate

    Physiatrist
    Université de Montréal / Hôpital du Sacré-Cœur de Montréal
    Montreal, Quebec, Canada

    • Co-Author/Coautor(s)

  • MD

    Maude Duguay, MS

    Medical student
    Université de Montréal
    Montréal, Quebec, Canada

    • Corresponding Author/Autor a quien dirigir la corr(s)

  • AR

    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

    • Co-Author/Coautor(s)

  • JM

    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

  • JC

    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

Objectives : The digital rectal examination (DRE) remains the clinical standard for assessing neuro-sacral function after spinal cord injury or lesion (SCI/L), but it is subjective, invasive, and heavily dependent on examiner expertise. Surface electromyography (s-EMG) offers an objective alternative, yet remains underutilised in clinical practice. This study aimed to: 1) develop and validate the ElectroSacroGram (ESG), an innovative s-EMG tool assessing sacral motor (resting tone, maximal voluntary anal contraction [maxVAC], bulbocavernosus reflex [BCR]) and sensory (electrical perceptual threshold [EPT]) functions; and 2) evaluate its diagnostic performance in detecting radiologically confirmed SCI/L.

Design:

In this prospective cohort study at a specialized Level 1 trauma center, 52 patients with suspected SCI/L and 21 healthy participants underwent ESG assessment. An expert panel of nine SCI/L specialists defined the ESG protocol based on established DRE parameters. Content validity was determined using item and scale content validity indices (I/S-CVI). ESG-DRE agreement was assessed with Cohen’s kappa, and diagnostic performance was evaluated against imaging findings.

Results: Healthy participants established normative ESG values. Neurologically impaired patients showed reduced maxVAC and BCR amplitudes and elevated EPT. ESG demonstrated perfect content validity (S-CVI=1) versus poor validity for DRE (S-CVI=0.43). ESG identified VAC in 3% of cases missed by DRE, with near-perfect agreement for VAC (κ=0.876) and EPT (κ=0.881). ESG achieved 83.3% sensitivity, 100% specificity, and 86.5% accuracy.

Conclusion: The ESG is a transformative, point-of-care tool delivering objective, real-time neuro-sacral assessment. By surpassing the limitations of DRE, it holds promise to redefine early SCI/L diagnosis. Multi-centre validation is now warranted to support clinical adoption.