Spinal shock

Definition

Spinal shock is a result of severe spinal cord injury. It usually requires high-impact, direct trauma that leads to spinal cord injury and spinal shock.

Cause

• It usually requires high-impact, direct trauma that leads to spinal cord injury and spinal shock. [1].
• The initial encounter with a patient that has spinal shock is usually under a trauma scenario.
• Ischemia of the spinal cord can also produce a spinal shock, for example, a hypotensive patient in the medical intensive care unit (ICU) or a post-angiography patient with thrombotic occlusion of arteries that supply the cervical spine.

Epidemiology

• Young men in their second decades of life are prone to spinal cord injury and clinical diagnosis of spinal shock.
• Among cases of spinal shock, 45% are due to motor vehicle accidents (MVA), 34% domestic accidents such as falls, 15% sporting accidents, 6% self-harm.

Signs and symptoms

• In spinal shock, there is a transient increase in blood pressure due to the release of catecholamines.
• This is followed by a state of hypotension, flaccid paralysis, urinary retention, and fecal incontinence.
• The symptoms of spinal shock may last a few hours to several days/weeks.
• Primary spinal cord injury may be due to transection, mechanical injury, gunshots, abscess, metastatic disease or distraction of the nerves.
• These injuries are usually associated with dislocation and/or fracture of the vertebral bodies.
• Secondary spinal cord injuries may be due to occlusion or disruption of arterial blood supply.
• The hypoperfusion leads to anoxic damage to the spinal cord.

Diagnosis

• After the initial trauma, evaluation is completed, and if the patient is stable enough to undergo imaging, a complete spinal computed tomogram (CT) should be the initial imaging obtained. [2].
• MRI spine imaging is very helpful but should not be the initial imaging modality.
• Myelogram would be helpful if the spinal shock is associated with canal compromise after fracture and would be the imaging of choice if the patient cannot obtain an MRI.

Other studies that are always done include:

• Levels of lactate
• Arterial blood gas to assess ventilation and oxygenation
• Complete blood count to assess hemoglobin levels

Treatment

• The cause of hypotension has to be treated.
• Hemorrhage may be due to injury in the chest or abdomen.
• Fluid resuscitation is vital.
• Crystalloid is often used to reverse the hypotension.
• The goal should be to bring the blood pressure at 90-100 mm Hg systolic.
• Oxygenation should be maintained and bradycardia managed with atropine.
• A Foley should be inserted and the output monitored.
• Some patients may benefit from low dose dopamine.
• Spinal shock patients should be treated in an ICU setting, as many complications should be expected to arise due to the injury.
• Methylprednisone treatment is controversial with some trials showing modest benefit and some other showing more negative side effects than benefits.
• Norepinephrine drip and judicious use of atropine for bradycardia should be part of the initial treatment.
• Eventually, within few days hypotension improves, and intravenous (IV) drips should be gradually decreased.'
• Deep vein thrombosis is excessively high in these patients.
• Prophylaxis should be initiated as soon as possible within days of the injury.
• Long-term management of spinal shock injury patients always requires multidisciplinary team treatment between different services.[3].

Prognosis

The outlook for spinal shock is guarded and depends on comorbidity, level of spinal cord injury, associated injuries, patient age and type of injury. If the condition does not reverse within 24 hours, most patients have a prolonged recovery and will require extensive rehabilitation.

NIH genetic and rare disease info

• NIH info on Spinal shock

Spinal shock is a rare disease.

Spinal shock Resources
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