Spinal Injuries
Ian Greaves, Keith Porter, Jeff Garner in Trauma Care Manual, 2021
For each mechanism of injury described earlier, there may be complete or incomplete (partial) cord injury. The distinction between complete and incomplete cord injury cannot, however, be made until the patient has recovered from spinal shock. Spinal shock is defined as the complete loss of all neurological function, including reflexes, anal tone and autonomic control, below the level of spinal cord injury. Spinal shock is unrelated to hypovolaemia or neurogenic shock and is effectively spinal concussion. It usually involves a period of 24–72 hours of complete loss of sensory, motor and segmental reflex activity with flaccid paralysis and areflexia below the level of the injury. Despite this profound paralysis, areas of the cord are still capable of a full recovery. Therefore, assessment of neurological status (ASIA Score) for outcome prediction reasons must be done after this period.
Cervical spine injury
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Anesthesia for Neurotrauma, 2018
Spinal shock refers to the transient loss of all neurologic function below the level of injury, which usually accompanies complete SCI. The initial phase of spinal shock results in flaccid paralysis (weakness or paralysis and reduced muscle tone without other obvious causes) and areflexia absent reflexes) and is caused by loss of function of descending motor and autonomic pathways. After the first 24 to 72 hours, partial recovery of spinal cord-level reflexes occurs. Subsequently, as a result of synaptic remodeling and a lack of descending inhibitory pathways, spasticity will occur. Partial SCI may also result in spinal shock in the initial phase of injury due to a “concussion” of the spinal cord, but with a potential for more complete recovery and a better prognosis.24
Neuromuscular Disorders
Louis Solomon, David Warwick, Selvadurai Nayagam in Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
The pattern of motor and sensory impairment suggests the level of cord involvement: Cervical cord: LMN weakness and sensory loss in arms; UMN signs in the lower limbs.Thoracic cord: UMN paresis in lower limbs; variable sensory impairment.Lumbar cord: combination of UMN and LMN signs in lower limbs.Cauda equina: LMN signs and sensory loss in lower limbs, plus urinary retention with overflow.Spinal shock: acute cord lesions may present with a flaccid paralysis which resolves over time, usually to reveal the typical UMN signs associated with cord injury.
Factors influencing thigh muscle volume change with cycling exercises in acute spinal cord injury – a secondary analysis of a randomized controlled trial
Published in The Journal of Spinal Cord Medicine, 2022
Maya G. Panisset, Doa El-Ansary, Sarah Alison Dunlop, Ruth Marshall, Jillian Clark, Leonid Churilov, Mary P. Galea
Spinal cord injury (SCI) results in substantial muscle atrophy below the neurological lesion, with significant repercussions for functional recovery and longer-term health.1 The acute physiological response to traumatic SCI involves a period of spinal shock, which may take some weeks to resolve.2 The combination of flaccid paralysis and decreased activity in the acute period causes rapid atrophy of skeletal muscle tissue. Loss of 33–45% of thigh muscle cross-sectional area (CSA) occurs as early as six weeks after SCI.3 Further atrophy (27–56%) has been reported from 6–24 weeks in patients with complete lesions.4 Atrophy occurring prior to neurological recovery may delay functional outcomes, as muscle strength must be regained.5 In animal studies, wheelchair immobilization in the first few weeks post-injury was associated with ongoing deficits in stepping behavior and coordination for months after re-mobilization.6 On the other hand, sensory feedback from rhythmic limb movement during locomotor training and cycling exercise in animal studies is thought to drive improvements in functional recovery after SCI via promotion of exercise-dependent neuroplasticity.7 Another study found that muscle to body weight ratios were maintained in both the plantaris and soleus muscles with four weeks of passive cycling (PC), initiated one week after injury in rats.8
Nurses and physiotherapists’ knowledge levels on autonomic dysreflexia in a rehabilitation hospital
Published in The Journal of Spinal Cord Medicine, 2023
Autonomic dysreflexia (AD) is a clinical condition that occurs mostly through uncontrollable sympathetic activity that is triggered by a sensory stimulus in patients with spinal cord injuries. AD, which can develop as a result of stimulation below the lesion level in cutaneous or visceral organs, is frequently observed with lesions above the T6 level, but can also occur in lesions up to T10. Several causes may trigger AD attacks; bladder distention and/or irritation are responsible for 80% of cases.3–6 Although AD characteristically occurs after the spinal shock period at the chronic phase of the injury, it can also occur in any time following the injury. The first attack is usually observed within approximately six months following the SCI, however, it can be observed in 5.2% of cases within the first month.8,9
Midsagittal tissue bridges are associated with walking ability in incomplete spinal cord injury: A magnetic resonance imaging case series
Published in The Journal of Spinal Cord Medicine, 2020
Denise R. O’Dell, Kenneth A. Weber, Jeffrey C. Berliner, James M. Elliott, Jordan R. Connor, David P. Cummins, Katherine A. Heller, Joshua S. Hubert, Megan J. Kates, Katarina R. Mendoza, Andrew C. Smith
The time-frame to establish a prognosis of residual motor function based on physical examination varies from 72 h up to 1-month post injury.3 Spinal shock, a condition characterized by complete loss of responses to external or internal stimuli of the body due to the sudden removal of descending inputs,4 could very well contribute to the limited prognostic value of physical examination findings alone. Furthermore, restoration of normal nerve function after SCI can take up to 2 months or even longer.4 Beyond isolated physical examination findings exists a need for early objective methods to effectively and reliably predict walking recovery following SCI on a patient-by-patient basis.