The Aminoff-Logue grading scale is a clinical assessment tool used to measure the degree of neurological disability caused by spinal vascular malformations — most notably spinal arteriovenous malformations (AVMs) and spinal arteriovenous fistulas (AVFs). It was described in 1974 by Michael Aminoff and David Logue.
What Does It Measure?
The scale assesses two core functional domains independently: gait and sphincter function (bladder and bowel control). These two domains are scored separately, with a distinct grade assigned to each.
Gait Grading
Ambulatory function is evaluated across six levels, from 0 to 5.
0 — Normal gait, no limitations whatsoever.
1 — Weakness or abnormal gait is present, but the patient is able to walk without assistance.
2 — The patient requires one stick or a single crutch to walk.
3 — The patient requires two sticks or two crutches.
4 — The patient can walk only with support or with the aid of a frame.
5 — The patient is wheelchair-dependent or bedridden.
Sphincter Grading
Bladder and bowel function is evaluated across four levels, from 0 to 3.
0 — Normal sphincter control.
1 — Urinary and/or fecal urgency or mild incontinence.
2 — Moderate urinary and/or fecal incontinence.
3 — Complete urinary and/or fecal incontinence.
Clinical Use
The scale is most widely used in patients diagnosed with spinal dural arteriovenous fistula (SDAVF). It enables objective comparison of neurological status before and after treatment, facilitates assessment of the efficacy of surgical or endovascular intervention, and allows meaningful comparison of outcomes across different centers.
Spinal dural AVF is a condition that can cause a slowly progressive myelopathy that frequently goes unrecognized for a prolonged period. The Aminoff-Logue scale provides a concrete means of documenting neurological deterioration or improvement as these patients are followed over time.
Strengths of the Scale
The primary reason clinicians have embraced the Aminoff-Logue grading scale is its simplicity. It requires no specialized equipment or laboratory testing and can be administered in the course of a brief neurological assessment. Its capacity to measure gait and sphincter function independently is particularly valuable in spinal vascular disease, where these two domains do not always follow a parallel course.
Limitations of the Scale
Like any clinical scale, the Aminoff-Logue grading system has certain limitations. Its failure to capture sensory deficits, pain, and upper extremity involvement stands out as a notable shortcoming. Furthermore, certain intermediate steps in the gait score — particularly in patients using mixed forms of support — can be interpreted differently between observers. For these reasons, some investigators prefer to modify the scale or to use it in conjunction with other neurological assessment tools.
Significance
The Aminoff-Logue grading scale has remained in continuous use in the field of spinal vascular disease for more than half a century. The vast majority of contemporary clinical studies in this area still reference this scale when reporting treatment outcomes. Its straightforward structure and its long track record in both clinical and research practice ensure that it remains an indispensable instrument for evaluating neurological outcomes in spinal vascular pathology.