Anorectal examination can be crucial in classifying spinal cord injuries, but there is much more to explore - it is one piece of the puzzle, but not the entire puzzle

The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) remain the reference framework for classifying spinal cord injury, with the absence of deep anal pressure and voluntary anal contraction defining complete injury (AIS A). Accumulating evidence, however, suggests that anorectal examination alone may not fully capture residual physiological connectivity in some individuals clinically classified as complete. Neurophysiological studies have reported preserved sensory, motor, or autonomic conduction despite the absence of sacral sparing on standard examination, challenging the conceptual boundaries between complete and incomplete injury. This commentary argues for a refined and integrative interpretation of neurological assessment that preserves the central role of ISNCSCI while incorporating complementary neurophysiological information and systematically collected patient‑reported manifestations. Rather than proposing reclassification or operational thresholds, the perspective presented is conceptual and hypothesis‑generating. Emphasizing preserved connectivity and neuroplastic potential may enhance prognostic understanding and support more individualized rehabilitation approaches. Future progress will depend on prospective validation studies, methodological standardization, and expert consensus to determine how multimodal information may responsibly inform classification without compromising clinical reliability.