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Review Paper | Surgery | Volume 15 Issue 6, June 2026 | Pages: 1529 - 1539 | India
Beyond ASIA: Rationale for a Multidomain Spinal Cord Injury Classification and Proposal of the MOSAIC-SCI Framework
Abstract: The American Spinal Injury Association Impairment Scale, derived from the International Standards for Neurological Classification of Spinal Cord Injury, remains the global standard for neurological classification after spinal cord injury. It provides a reproducible method for documenting neurological level, sensory and motor impairment, sacral sparing, completeness of injury, and neurological recovery. However, spinal cord injury is not only a sensorimotor disorder. It is also a mechanical, radiological, autonomic, functional, temporal, and patient-centered condition. The ASIA Impairment Scale does not directly classify vertebral-column instability, MRI cord lesion burden, autonomic dysfunction, respiratory compromise, bladder and bowel dysfunction, sexual dysfunction, neuropathic pain, functional independence, examination reliability, pediatric limitations, geriatric frailty, or confounding neurological and musculoskeletal conditions. This review examines the major limitations of using AIS as a stand-alone spinal injury severity descriptor and proposes an adjunctive multidomain framework termed MOSAIC-SCI. MOSAIC-SCI represents Mechanical morphology, Objective cord imaging, Sensorimotor neurology, Autonomic function, Independence/function, and Confounders/context. The proposed classification retains ISNCSCI/AIS as the neurological core but embeds it within a broader clinical profile relevant to acute care, surgical decision-making, rehabilitation planning, outcome prediction, and patient-centered documentation. MOSAIC-SCI is presented as a hypothesis-generating framework requiring prospective multicenter validation before clinical adoption.
Keywords: Spinal cord injury, ASIA Impairment Scale, ISNCSCI, spinal cord medicine, autonomic dysfunction, spinal trauma, MRI, functional outcome, SCIM, classification
How to Cite?: Dr. Nishant, "Beyond ASIA: Rationale for a Multidomain Spinal Cord Injury Classification and Proposal of the MOSAIC-SCI Framework", Volume 15 Issue 6, June 2026, International Journal of Science and Research (IJSR), Pages: 1529-1539, https://www.ijsr.net/getabstract.php?paperid=SR26626065159, DOI: https://dx.doi.org/10.21275/SR26626065159