Spinal cord injuries can affect many functions, interfere with the activities of daily living, and result in significant impairment. This article reviews cauda equina and conus medullaris syndromes, examines the process of rating corticospinal tract damage, and provides a case example. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), cauda equina syndrome refers to the polyradicular symptomatology resulting from single- or double-level compression of the lumbosacral nerve roots in the dural sac and may include low-back pain, saddle anesthesia, sciatica, motor weakness of the lower extremities, chronic paraplegia, and bladder, bowel, or sexual dysfunction. Conus medullaris syndrome is caused by a compression injury at T12 or L1, and flaccid paralysis of the legs and anal sphincter with variable sensory deficits may be present. The AMA Guides, Fifth Edition, includes Table 15-6, Rating Corticospinal Tract Impairment, which presents criteria for rating the neurological impairment. The physician must determine which systems are impaired, then which categories are appropriate and what value within a range should be selected. This requires the use of judgment because large ranges are provided. Spinal injuries that involve corticospinal tract damage are assessed using the Diagnosis-related estimate (DRE) method, but the range-of-motion method can be used in specified situations. A case example demonstrates how to assess neurological impairment.