- Clinical science
Complete spinal cord injury is the complete sensory and motor loss below the site of spinal cord injury following acute or chronic destruction, compression, or ischemia of the spinal cord. Initially, this may present as spinal shock, which is an acute physiological loss or depression of spinal cord function. It presents as a flaccid areflexic paralysis below the level of the injury with autonomic features (e.g., hypotension and bradycardia). After some days to weeks the spinal shock wears off and a complete spinal cord injury may remain. It presents with spastic paresis, hyperreflexia, and continued sensory loss. Acute stabilization, a thorough neurological examination, and imaging is required for adequate diagnosis. Treatment involves acute care (e.g., analgesia, urinary catheterization) and definitive treatment (bracing or surgery). Symptomatic treatment, assistant devices, and physical therapy can improve mobility and quality of daily life. Less than five percent of cases fully recover after complete spinal cord injury.
- Definition: acute physiological loss or depression of spinal cord function ; (loss of all sensorimotor functions below the level of injury) that lasts several hours to weeks following a spinal cord injury
- Etiology: Traumatic spinal cord injury
Flaccid areflexic paralysis
- Paraplegia or tetraplegia, if cervical cord is involved (in ∼ 50% of cases in the US)
- Sensory disturbances: analgesia and anesthesia
- Areflexia: absence of the proprioceptive and polysynaptic reflexes (e.g., abdominal reflex)
- Loss of bladder control: urine retention, bladder distention, and dribbling incontinence
- Loss of bowel control: paralytic ileus
- Impaired breathing
- Hypotension and bradycardia
- Absent bulbocavernosus reflex → incontinence
- Male patients might develop
- After 48–72 hours: spasticity, hyperreflexia, and clonus
- Flaccid areflexic paralysis
- Diagnostics and treatment: see “E
- Usually reversible, it is difficult to predict the outcome and remaining disabilities in this acute phase.
- Poor, if transition to occurs
- Better, if transition to occurs
If a spinal injury is suspected (trauma to the neck or back), the affected patient should be moved with extreme care to avoid further damage to the spine!
- Complete bilateral loss of sensation and motor function below a spinal cord injury lesion.
- ∼ 25% of annual spinal cord injuries in the US
- may develop into complete spinal cord lesions
- Trauma (complete transection)
- Spinal tumors, , or myelitis
- Extradural pathologies (e.g., infarction, or acute disc herniation , ),
- Acute or chronic spinal cord injury (e.g., fracture, dislocation, or penetrating injury)
- → destruction (e.g., trauma), compression (e.g., hematoma), or ischemia (e.g., injured spinal arteries) of spinal cord
- → incomplete or complete spinal cord injury
- Symptoms of complete spinal cord injury occur 6-8 weeks after spinal shock has worn off.
- Spared sensory levels above lesion
- Reduced sensation next to caudal level
Bilaterally absent sensory and motor function below the lesion (including lowest sacral segments S4–S5)
- Impaired sensation (i.e., to pain, position, etc.)
- Muscle hypertonia with
- Increased proprioceptive reflex: hyperreflexia
- Inexhaustible clonus: e.g., ankle clonus
- Anal reflex remains absent
- Pathological reflexes: e.g., upgoing plantar reflex (also known as the )
- Spastic bladder: involuntary urination caused by contractions
- Possibly erectile dysfunction in men
- Stabilize patient
- Exclude bulbocavernosus reflex) or (i.e., determine
- Determine level of injury
- Determine extent of injury (complete or incomplete)
- Exclude associated injuries
- Rehabilitation (multidisciplinary care)
- Early mortality: 4–20%
- < 5% chance of recovery
- In complete thoracic and lumbar injury, up to ∼ 8% of patients can still walk with the assistance of special devices.
- Leading causes of death are pneumonia, pulmonary embolism, and suicide.
- Prevention: Avoid risk-taking behavior (e.g., diving head first into shallow water or drunk diving) and implement safety precautions in high-risk occupations
In acute spinal cord injury (spinal shock), flaccid paralysis and a complete absence of reflexes occur below the injury. A change in symptoms occurs after a period of 6–8 weeks and includes spastic paralysis, recurrence of proprioceptive reflexes as hyperreflexia, and the presence of pathological reflexes (e.g., plantar reflex)!