OBJECTIVE To assess sacral and lower-extremity pinprick preservation as prognostic indicators for ambulation in motor complete, sensory incomplete spinal cord injury (SCI). METHODS Retrospective analysis. METHODS Twenty-eight tertiary care centers in the United States and Canada. METHODS Subjects (N=131; mean age, 31.6y) with motor complete, sensory incomplete SCI. METHODS Not applicable. METHODS Ambulation at 26 and 52 weeks postinjury (modified Benzel scale). RESULTS A higher percentage of subjects with sacral pinprick preservation at baseline were ambulating at 26 (39.4% vs 28.3%) and 52 weeks (53.6% vs 41.5%). This finding did not reach statistical significance. The presence of sacral pinprick preservation at 4 weeks postinjury was significant for predicting ambulation at 52 weeks postinjury (36.0% vs 4.4%, P =.011) and approached significance at 26 weeks (15.2% vs 0.0%, P =.056). Significant differences in ambulation rates were also observed between subjects, based on the presence of baseline lower-extremity pinprick preservation (>/=50% of lower-extremity L2-S1 dermatomes) at both 26 (50.0% vs 28.8%, P =.048) and 52 weeks (66.7% vs 40.3%, P =.023) after injury. CONCLUSIONS Baseline lower-extremity pinprick preservation and sacral pinprick preservation at 4 weeks postinjury are associated with an improved prognosis for ambulation.