The people often say: a certain doctor has cured a patient who has been paralyzed in bed for decades to stand up again. Anyone with common sense knows that this is nonsense. For a professional spine surgeon, an early and clear diagnosis is crucial to determine the prognosis and to determine the treatment plan and surgical approach. The question is how is the diagnosis made? First, I need to be clear: spinal shock? Spinal cord concussion? Complete spinal cord injury? Spinal shock is, as the name implies, “shock” is a brief process. Spinal shock usually recovers shortly and lasts from a few hours to a few weeks, mostly 1 to 6 weeks but possibly months. During recovery, primitive simple reflexes recover first and complex advanced reflexes recover later. The earliest recoveries are the bulbocavernosal and anal reflexes, which recover from the caudal to the cephalic direction. Spinal cord concussion is similar to concussion in that there is no damage to the spinal cord parenchyma, which is clinically manifested by complete loss of sensation, movement and reflexes below the plane of injury. Usually, after a few hours to 2-3 weeks, motor sensation begins to recover without any neurological sequelae. Complete spinal cord injury has complete transverse damage to the spinal cord parenchyma, with complete loss of sensory and motor functions in the lowest level below the plane of injury, i.e., the sacral segment, including perianal sensation and contractile movements of the anal sphincter, without the presence of the bulbocavernosus reflex. In general, spinal cord shock without spinal cord parenchymal injury, complete spinal cord injury is transverse and completely broken, between the two is the spinal shock incomplete spinal cord injury. Are those cured by the doctors “complete spinal cord injury”? Of course, the answer is no. At this point in the article, it’s time to talk about how to pull the plug. To do this, you need to check the bulbocavernosus reflex. How do you do it? A positive bulbocavernosus reflex is caused by stimulating the bladder triangle (squeezing the glans, stimulating the clitoris or pulling the catheter) to cause contraction of the anal sphincter. The return of a positive bulbocavernosal reflex is a sign that recovery from spinal shock has begun. If it is negative, meaning that there is no contraction of the anus after the tug, then unfortunately, the patient’s prognosis is poor. Now let’s get straight to the point: diagram of the male bulbocavernosus reflex, female bulbocavernosus reflex