3. Definition
3
Immediate temporary loss of total power,
sensation and reflexes below the level of injury
+ Loss of bulbo-cavernous reflex
Usually recover within 24-48 hrs
-oxford handbook-
6. 6
Walter B. Greene. Netter's Orthopaedics 1st ed. 2006
7. Pathophysiology
7
TRAUMA -- > SCI
- causes a concussion like injury to spinal cord
- total sensory and motor power loss and loss of all reflexes for
initial some period
- followed by then gradual recovery of reflexes
Reflexes in the SC caudal to the SCI are depressed
(areflexia)
This state of sensory and motor loss along with total loss of
reflexes following trauma is known as spinal shock
The 'shock' in spinal shock does not refer to circulatory
collapse
8. Phases
Phase Time Physical exam
findings
Underlying physiological
event
1 0-1 days Areflexia Loss of descending
facilitation
2 1-3 days Initial reflex return Denervation
supersensitivity
3 1-4 weeks Hyperreflexia Axon-supported synapse
growth
4 1-12 months Hyperreflexia,
Spasticity
Soma-supported synapse
growth
http://www.nature.com/sc/journal/v42/n7/full/3101603a.html
8
9. Phase 1:
A complete loss or weakening of all reflexes below
the level of spinal cord injury
Spinal concussion caused the neurons involved in
various reflex arcs and the neural input from the
brain become hyperpolarized and unresponsive.
9
10. Phase 2
Characterized by the return of some reflexes. The
first reflexes to reappear is the bulbocavernosus
reflex
The reason reflexes return is the hypersensitivity of
reflex muscles following denervation; more
receptors for neurotransmitters are expressed and
are therefore they are easier to stimulate.
10
11. Phases 3 and 4
Characterized by hyperreflexia
Neurons below the injury attempt to reestablish
the synapses
11
12. Spinal vs neurogenic shock
12
Spinal shock Neurogenic shock
Definition Immediate temporary loss
of total power, sensation
and reflexes below the level
of injury
Sudden loss of the
sympathetic nervous
system signals
BP Hypotension Hypotension
Pulse Bradycardia Bradycardia
Bulbocaverno
Absent Variable
sus reflex
Motor Flaccid paralysis Variable
Time 48-72 hrs immediate after SCI
Mechanism Peripheral neurons become
temporarily unresponsive to
brain stimuli
Disruption of autonomic
pathways loss of
sympathetic tone and
vasodilation
http://www.orthobullets.com/spine/2006/spinal-cord-injuries
13. 13
MANAGEMENT
Immobilisation
-Spinal board
-Cervical collar
1) Monitor
neurological status
2) Cord/cauda-equina
Sx
Methylprednisolone
-given as bolus of 30 mg
/ kg body wt
-followed by infusion at
5.4 mg / kg / hour for 24
hours
Symtomatic
medication:
-Pain relief
-Constipation
DVT prophylaxis
14. The National Spinal Cord Injury Study
(NASCIS)
14
NASCIS 3 USA, 1997
High dose methylprednisolone
Prevent secondary injury of SCI
Rx start within 3 hrs for 24 hrs
Side effects: immunosuppression, GIT bleeding,
hyperglycemia and ARDS
- How to do it?
Male & female with cbd
Female without cbd
Why it is important?
Recovery of spinal shock
Can comment on complete/incomplete sci
Prognosis n mx for pt
- Ths reflexes are LMN origin
Explain more about dermatomes of LL
C7 T12 L5 S5 Coccyx
Hypotension and bradycardia in spinal shock when the SCI at thoracic, area of sympathetic nerve origin
Cauda equina syndrome:
Characterized by
Asymmetrical areflexia, numbness at saddle area, urinary/bowel incontinence
Side effect of high dose steroid
Reduced immunity start abx
Git bleeding cover with ppi