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Spinal cord injury (SCI) can be life changing and is associated with a variable prognosis. The descriptions of symptoms of the injury are as old as the pyramids, probably among the earliest case records are from the Edwin Smith Surgical papyrus that dates back to 2500‐3500 BC. In that day and age it was considered ‘an ailment not to be cured [treated]’. However, in the 21st century things are viewed differently. The quality of life, morbidity, mortality and participation in employment and sports following spinal injuries have been revolutionised by understanding the pathology and setting standards and principles of management of care pioneered by Sir Ludwig Guttmann during the second world war who established the first spinal injuries centre at Stoke Mandeville in 1944. The principles have been replicated all over the world and have led to much improved outcomes in patients with spinal injuries. The current annual incidence of spinal injuries in the UK is 10‐15 per million population. 1 A symposium was organised a tribute to the last student of Sir Ludwig Guttmann, Professor Wagih Shafik El-Masri on as his 65th birthday. This was organised by his colleagues at the Midlands Centre for Spinal Injuries, Robert Jones and Agnes Hunt Orthopaedic Hospital and attended by 150 delegates (colleagues and friends of Professor El Masri). Guest speakers were invited from various parts of the world. The forum discussed various important learning points and observations from eminent professors in the field of spinal injuries where there is a dearth of level 1 evidence in many aspects of care. This forum also discussed various research projects on the horizon. The need for improved standards of SCI training across Europe was also highlighted. Professor Hans Frankel, an eminent neurologist from Stoke Mandeville discussed his ideas and the origins of the Frankel classification which is widely used in the classification of neurological deficit in SCI. 2 The Medical Research Council (MRC) scale was ordinal only and failed to demonstrate the functional deficit. His classification eliminated observer bias by recording functional abilities, though today, the version used in day-to-day practice tends to be the ASIA scale of impairment which also includes sacral sparing on initial examination. He also opined that regular digital per rectal examination may not add more information than performing a perineal pin prick examination. He concluded that in his experience, managing spinal injuries is easy but not simple. He suggested that electrical perceptual threshold based on skin resistance is the quantitative way of measuring sensation though currently this is mainly used for research purposes. 3

From the age of the pyramids to the superfast world–what has changed in the management of spinal injuries?