Spinal shock

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Spinal Shock

Spinal shock is the altered physiologic state immediately after a spinal cord injury, which present as loss spinal cord function caudal to the level of the injury, with flaccid paralysis, anesthesia, absent bowel and bladder control, and loss of reflex activity.

Phases of spinal shock:

§  Areflexia/ hyporeflexia (below normal reflexes), flaccid paralysis, loss of sensation

§  Initial reflex return

§  Early hyperreflexia

§  Late hyperreflexia.

Pathophysiology of spinal shock:

§  The transection of the spinal cord results in spinal shock and transient extinction of reflexes below the level of injury.

§  The main pathophysiological mechanisms include: Synaptic changes in cord segments below the level of injury due to enhancement of presynaptic inhibition and high concentration of glycine.

Causes of spinal shock:

§  Spinal shock is a result of severe spinal cord injury.

§  It usually requires high-impact, direct trauma that leads to severe spinal cord injury and spinal shock.

§  The initial encounter with a patient with spinal shock is usually under a trauma scenario.

§  Spinal shock is caused by swelling following damage to the spinal cord. Generally, swelling peaks at about 3-6 days post-injury.

§  Swelling of the spinal cord can further restrict blood flow, which disrupts the delivery of oxygen and other essential nutrients to tissues.

§  As a result, autoregulation below the level of injury becomes impaired. Our bodies need blood to fuel cellular activity. Without sufficient amounts of it, cells may be damaged and the body can start to dysfunction.

Signs and symptoms of spinal shock:

§  Loss of reflexes.

§  Altered body temperature.

§  Loss of motor control.

§  Skin color and moisture changes.

§  Low blood pressure – if the SCI occurs at the T6 level or higher.

§  Abnormal perspiration – decreased or increased sweating, flushing.

§  Decreased heart rate – if the spinal cord injury at the T6 level or higher.

§  Irregularities in the musculoskeletal system.

§  Flaccid paralysis. Weakness, incoordination or paralysis in any part of the body.

§  Spasms/increased muscle tone.

§  Loss of bladder or bowel control.

§  Numbness, tingling or loss of sensation in hands, fingers, feet or toes.

§  Difficulty with balance and walking.

Characteristic of spinal shock:

§  Motor effects – Paraplegia, quadriplegia

§  Loss of tone – Muscles become flaccid

§  Areflexia – All superficial and deep reflexes are lost

§  Sensory effects – All sensations are lost below the level of transection

§  Complete lesions above T1 will eliminate all sympathetic outflow

§  Lesions between T1 and T6 will preserve sympathetic tone in head and upper extremities but deny it to the adrenals and lower extremities

§  Lesions between T6 and the lumbar cord will preserve adrenal innervation but denervation the lower extremities. 

Manifestations of spinal shock:

§  Spinal shock is characterized by a temporary rise in blood pressure that is proceeded by hypotension, flaccid paralysis, urinary retention and fecal urinary incontinence.

§  If reversal of symptoms does not occur within 24hrs, it may call for protracted recovery time and lengthened stay in rehabilitation.

Vitamins for spinal cord injury:

Vitamin B12:

§  Vitamin B12 deficiencies can cause tiredness, weakness, constipation, loss of appetite, tingling, and numbness.

§  This vitamin also plays a fundamental role in producing red blood cells, which are essential for carrying oxygen throughout the body.

§  Vitamin B12 in foods like fish, meat, and dairy.

Vitamin B9:

§  It comes in 2 different forms: folate and folic acid.

§  Folate is naturally, derived and found in dark green vegetables like spinach, asparagus, and broccoli.

§  Folic acid is the synthetic form of B9 that you can find in pills.

§  Folic acid can effectively reduce the occurrence of neural tube defects in newborns.

Vitamin D:

§  Due to paralysis, many individuals with spinal cord injuries lose the ability to independently stand and walk.

§  Vitamin D aids the absorption of calcium in the body, which is essential for maintaining strong bones.

§  It also helps trigger immune cells to produce antibodies, which helps strengthen the immune system and protect the body.

§  One of the best ways to get daily dose of vitamin D is to get out in the sun.

§  Vitamin D in foods like fatty fish and egg yolks or take supplements.

Omega-3 fatty acids:

§  Docosahexaenoic acid is an omega3- fatty acid that is essential for central nervous system health.

§  The excessive release of glutamate overstimulates the spinal cord and causes neurons to die in a process called excitotoxicity. DHA helps prevent excitotoxicity by regulating glutamate levels, which helps reduce overall damage to the spinal cord.

§  Good food sources of omega-3 include flaxseeds, walnuts, and salmon.

Vitamin C:

§  Vitamin C is essential for spinal cord injury recovery because it helps the body repair tissues and produce neurotransmitters.

§  Vitamin C is also a well-known antioxidant that can help combat oxidative stress and limit cell deaths after a spinal cord injury.

§  It can be found in lots of fruits and vegetables, including citrus fruits, strawberries, and red peppers.

Magnesium:

§  Magnesium has neuroprotective properties that can help limit secondary damage to the spinal cord.

§  It also plays an important role in various bodily reactions including nerve impulse conduction, muscle contractions, and energy protection.

§  Good sources of magnesium include spinach, pumpkin seeds, and tuna.

Vitamin E:

§  Vitamin E is a major antioxidant that can help reduce oxidative stress and overall damage after a spinal cord injury.

§  It is also involved in immune functions, signaling between cells, and other metabolic processes.

§  Vitamin E can be found in foods like sunflower seeds, almonds, and vegetable oils.

Treatment:

§  Physical therapy.

§  Exercise therapy to strengthen muscles and maintain a healthy body weight.

§  Psychotherapy to aid in coping with and managing the injury.

§  Early medical intervention is crucial in the treatment of spinal cord injuries. By stabilizing the spinal cord as quickly as possible, the individual’s medical team may minimize the progression of swelling and other secondary processes that contribute to spinal shock. This helps reduce overall damage to the spinal cord.

§  As a temporary outcome of spinal cord should resolve on its own.

§  Medications such as painkillers, antibiotics, and antidepressants.