Bulbocavernosus Reflex Has No Prognostic Features during the Acute Evaluation of Spinal Cord Injuries

Daniyal Mansoor Ali*, Ahilan Sivaganesan, Chris J. Neal, Sara Thalheimer, Beatrice Ugiliweneza, Elizabeth G. Toups, Muhammad Abd-El-Barr, George Jimsheleishvili, Shekar N. Kurpad, Bizhan Aarabi, Christopher I. Shaffrey, Michael G. Fehlings, Charles H. Tator, Robert G. Grossman, James D. Guest, James S. Harrop

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


The bulbocavernosus reflex (BCR) has been used during the initial evaluation of a spinal cord injury patient as a metric to determine prognosis and whether the patient is in "spinal shock."This reflex has been less utilized over the last decade, and therefore a review was performed to assess the value of BCR in patient prognosis. The North American Clinical Trials Network (NACTN) for Spinal Cord Injury (SCI) is a consortium of tertiary medical centers that includes a prospective SCI registry. The NACTN registry data was analyzed to evaluate the prognostic implication of the BCR during the initial evaluation of a spinal cord injury patient. SCI patients were divided into those with an intact or absent BCR during their initial evaluation. Associations of participants' descriptors and neurological status on follow-up were performed, followed by associations with the presence of a BCR. A total of 769 registry patients with recorded BCRs were included in the study. The median age was 49 years (32-61 years), and the majority were male (n = 566, 77%) and white (n = 519, 73%). Among included patients, high blood pressure was the most common comorbidity (n = 230, 31%). Cervical spinal cord injury was the most common (n = 470, 76%) with fall (n = 320, 43%) being the most frequent mechanism of injury. BCR was present in 311 patients (40.4%), while 458 (59.6%) had a negative BCR within 7 days of injury or before surgery. At 6 months post-injury, 230 patients (29.9%) followed up, of which 145 had a positive BCR, while 85 had a negative BCR. The presence/absence of BCR was significantly different in patients with cervical (p = 0.0015) or thoracic SCI (p = 0.0089), or conus medullaris syndrome (p = 0.0035), and in those who were American Spinal Injury Association Impairment Scale grade A (p = 0.0313). No significant relationship was observed between BCR results and demographics, AIS grade conversion, motor score changes (p = 0.1669), and changes in pin prick (p = 0.3795) and light touch scores (p = 0.8178). In addition, cohorts were not different in surgery decision (p = 0.7762) and injury to surgery time (p = 0.0681). In our review of the NACTN spinal cord registry, the BCR did not provide prognostic utility in the acute evaluation of spinal cord injury patients. Therefore, it should not be used as a reliable marker for predicting neurological outcomes post-injury.

Original languageEnglish
Pages (from-to)1970-1975
Number of pages6
JournalJournal of Neurotrauma
Issue number17-18
StatePublished - 1 Sep 2023
Externally publishedYes


  • ASIA
  • bulbocavernosus reflex
  • prognosis
  • spinal cord injury


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