Spinal Shock

Excerpt

Spinal shock is the sudden, temporary loss or impairment of spinal cord function below the level of injury that occurs after an acute spinal cord injury (SCI), including the motor, sensory, reflex, and autonomic neural systems. The term "spinal shock" was first used by Hall in 1840. Sherrington further defined this as a transient disappearance of reflexes below the level of SCI. The most common cause of severe SCI leading to spinal shock is a primary insult by high-impact, direct trauma or fall. However, secondary injury (eg, ischemia or infection) of the spinal cord can also result in injury. Other causes of SCI include myelopathies induced by autoimmune, infectious, neoplastic, vascular, and hereditary-degenerative diseases. Although the condition may occur as a result of SCI, spinal shock is a physiologic process rather than an anatomic disorder. Spinal shock may last days to weeks, though there is debate on how the resolution of the condition is defined.

The diagnosis of spinal shock is comprised of obtaining relevant history (eg, past medical history, mechanism of injury), if possible, performing a complete physical examination, including evaluation with the Glasgow Coma Scale (GCS) and American Spinal Injury Association (ASIA) Scale, and initiating spinal imaging studies. As with any trauma patient, evaluation for SCIs should be performed after primary assessment with the ABCDE (ie, Airway, Breathing, Circulation, Disability, Exposure) protocol while ensuring spine immobilization during evaluation and transportation to minimize secondary injury. Initial characteristic findings of spinal shock include paralysis and absent reflexes, impaired bowel and bladder control, and absent anal sphincter tone.

If the spinal shock is not associated with significant injury of the spinal column itself, then the prognosis for these patients is more favorable than when a fracture is present. The overall treatment of patients with significant spinal shock and injury is a challenge, but aggressive medical management can reduce its effect on the overall functionality of the patient. Management of spinal shock primarily consists of maintaining hemodynamic and respiratory stability to prevent further neurogenic injury and supportive therapy. In some patients, surgical decompression may be considered. However, despite optimal care, deficits following spinal shock may be permanent. Typically, patients with spinal shock have restoration of spinal cord function after a period of recovery; persistent neurological impairment may indicate anatomic SCI. Clinicians should be knowledgeable in the appropriate management of spinal shock, equipping themselves with updated knowledge, skills, and strategies for timely identification and effective interventions to achieve improved interprofessional coordination of care, better patient outcomes, and reduced morbidity.