The predictive value of plantar flexion of the toes in the assessment of neuropathic voiding disorders in patients with spine lesions at the thoracolumbar level

Objective: To correlate the presence of voluntary contraction of the plantar flexors of the toes with neuropathic voiding disorders in patients with spinal cord injury (SCI) after thoracolumbar fracture. Subjects and Methods: Sixty-three SCI patients with thoracolumbar fractures were prospectively examined neurologically (American Spinal Cord Injury Association protocol) and urodynamically during their first hospitalization. To assess neurologic recovery, patients were reassessed after at least 1 year. Bladder function was also reevaluated and correlated to neurologic evaluation performed on the same day. Settings: Primary care center, university facility. Results: There was a significant correlation between score of the plantar flexors of the toes and the presence or absence of voluntary contraction of the external anal/urethral sphincter (p <.001). However, this was of no predictive value concerning neuropathic bladder type (p >.05). Seven patients recovered from their neuropathic voiding disorders. There was a significant correlation between the reappearance of a voluntary external anal/urethral sphincter contraction and bladder recovery (p <.01), but there was no significant correlation between the score obtained for the plantar flexors of the toes and the presence or absence of the bulbocavernosus reflex (p >.05). Conclusions: It appears that in SCI patients with thoracolumbar fractures, the presence of a voluntary contraction of the plantar flexors of the toes correlates with active contraction of the external anal/urethral sphincter but does not enable differentiation of the types of neuropathic voiding disorders. Urodynamic examination remains mandatory for assessment of the functional aspect of the neuropathic voiding disorders. (C) 1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.