The bulbocavernosus reflex (BCR) has no prognostic features during the acute evaluation of spinal cord injuries.


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 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. 769 registry patients with recorded BCRs were included in the study. The median age was 49 years (32-61 years), 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, respectively. 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 AIS 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.





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Publication Info

Mansoor Ali, Daniyal, Ahilan Sivaganesan, Chris J Neal, Sara Thalheimer, Beatrice Ugiliweneza, Elizabeth G Toups, Muhammad Abd-El-Barr, George Jimsheleishvili, et al. (2023). The bulbocavernosus reflex (BCR) has no prognostic features during the acute evaluation of spinal cord injuries. Journal of neurotrauma. 10.1089/neu.2022.0412 Retrieved from

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Muhammad Abd-El-Barr

Associate Professor of Neurosurgery

As a Neurosurgeon with fellowship training in Spine Surgery, I have dedicated my professional life to treating patients with spine disorders. These include spinal stenosis, spondylolisthesis, scoliosis, herniated discs and spine tumors. I incorporate minimally-invasive spine (MIS) techniques whenever appropriate to minimize pain and length of stay, yet not compromise on achieving the goals of surgery, which is ultimately to get you back to the quality of life you once enjoyed. I was drawn to medicine and neurosurgery for the unique ability to incorporate the latest in technology and neuroscience to making patients better. I will treat you and your loved ones with the same kind of care I would want my loved ones to be treated with. In addition to my clinical practice, I will be working with Duke Bioengineers and Neurobiologists on important basic and translational questions surrounding spinal cord injuries (SCI), which we hope to bring to clinical relevance.


Christopher Ignatius Shaffrey

Professor of Orthopaedic Surgery

I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.

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