Spinal shock: developmental mechanisms, symptoms, and treatment characteristics

Spinal shock is a phenomenon in neurology, which is caused by a traumatic effect on the spine with damage to the spinal cord. It is expressed in the sharp oppression of all reflex centers located in the spinal cord below the site of the injury. The artificial stimulation of reflexes above the affected area shows that the innervation is preserved there. As a consequence, there is a decrease in blood pressure, lack of dermographism, as well as disruption of the pelvic organs.

The mechanism of development

Strong blow to the body of a person, a fall from a height, an accident - all this can provoke a spinal shock. And the mechanisms of its development will be the same in all cases. The most common cause is a fracture of the spine, since damage to the spinal cord will not only be at the site of the injury, but also in areas where blood circulation and lymph drainage are disturbed. It is this area that can be restored with time.

Nature has a mechanism that protects tissues from greater damage. It consists in the fact that the activity of nerve cells is slowed down below the site of the injury, so the affected area is at rest and is restored more quickly. Transmission of nerve impulses along conductive paths ceases for the time of regeneration.

Diagnostics

Immediately after the trauma it is impossible to determine whether the spinal cord is damaged anatomically or functionally. Spinal shock is characterized by the reversibility of processes and complete or partial restoration of the function. The level of spinal injury forms a certain symptom complex, which makes it possible to diagnose the exact location of the lesion. For this, it is necessary to reveal the lowest part of the spinal cord responsible for normal innervation. This may take a while, but a general neurological examination will indicate the approximate area of the lesion.

After this, it is necessary to send the patient to the neuroimaging (CT or MRI) to find out the state of the segments of interest to the doctor.

Determination of sensitivity and motor activity

To determine the degree and level of lesions, the neurologist assesses the sensitivity and motor function of the patient's limbs on a five-point scale. Five points are normal indicators, and zero is a complete lack of response.

Muscles are examined symmetrically and in turn from the trunk to the extremities. All results are summarized, and an average total score is displayed, separate for sensitivity and for the motor sphere. The examination should be carried out several times during the entire duration of the patient's stay in the hospital, in order to monitor the restoration of functions in dynamics. For example, if, a month after the beginning of treatment, the patient's overall assessment of the motor function of the lower extremities is higher than fifteen points, which by the end of the year he is very likely to be able to walk.

Levels of defeat

The signs of spinal shock directly depend on the level of the lesion.

If the injury was at the level of the cervical vertebrae, it leads to immobilization of the upper and lower extremities. The function of respiration and palpitation is inhibited. Patients are forced to stay on the apparatus of artificial ventilation and for them there must be permanent care.

The defeat at the level of the lower segments of the cervical spine retains the normal operation of the upper limbs. But if the thoracic vertebrae are affected, the patient still has problems with breathing and heart rhythm. Damage at the level of the navel causes a spinal shock with immobilization of the muscles of the back and lower limbs, and also disrupts the work of the pelvic organs by the type of delay.

The most favorable option is a spinal cord injury at the level of the lumbosacral segment. Spinal shock in this case causes only impaired movement in the lower extremities while maintaining a part of the sensitivity.

Periods of the disease

The disease is partially or completely reversible, so a few months after the injury, patients feel better, they return to their lost functions. There are four stages of spinal shock.

1. Acute period, which lasts for the first three days after the injury. It is characterized by a complete absence of carrying out nerve impulses below the damage, regardless of the severity of the damage.

2. Subacute period takes about a month. At this time, the damaged structures of the spinal cord are restored, the appearance of scar tissue at the site of the injury, the normalization of blood circulation and lymph flow.

3. The interim period can last up to six months. At this stage, the central inhibition of nerve impulses ceases, only irreversible neurologic changes prevail in the clinic.

4. Late period, which can last several years after injury. This is the time of slow recovery of lost functions. But along with the likelihood of positive dynamics, it is also possible to scar tissue of the spinal cord at the site of injury and aggravation of neurologic symptoms.

It is useful for doctors and patients to remember that a complete lack of improvement in the first week is a poor prognostic sign and may indicate that the lost functions will not recover. And vice versa, if in the first week there were at least some changes, then the probability of full recovery is great.

Duration of the disease

Not only people have spinal shock. Physiology, in the broadest sense of the word, proves that in animals such a state is also possible. For example, in a frog it lasts up to five minutes, in dogs - about a week, monkeys are forced to endure inconveniences a month. People in this list are at the very last position. They have the greatest duration of spinal shock - two months.

If the spinal cord remains anatomically intact after the injury, then after a while the reflexes are restored. It all depends on how patient is treated and has faith in himself.

Therapeutic tactics

The earlier the victim is admitted to a medical institution, where he will be able to provide qualified assistance, the greater the chance that he will recover. In addition, the first aid and transportation is of great importance. It is necessary to transfer the patient carefully, only on a rigid board or shield, so as not to aggravate the damage.

To treat a spinal shock begin competently with the immobilization of the spine. Then, a number of surgical procedures are performed to decompress the spinal cord, remove fragments of the vertebrae, necrotic tissues and foreign bodies. After this, the surgeon makes plastic of lost bone formations.

Conservative therapy is the use of glucocorticosteroids, such as Dexamethasone or Prednisolone, and muscle relaxants of the central action - Midokalm, Sirdalud, Baclofen. The first relieve pain symptoms, swelling, reduce inflammation. And the second helps to relieve the burden on the spinal column.

Since the patient will be immobilized for a long time, he needs prophylaxis of pressure sores, massages, gymnastics and breathing exercises, to prevent pneumonia.

The chance of recovery

Complete immobility adversely affects the psyche of patients. People morally prepare themselves for the fact that for life they will be chained to a bed or a wheelchair and will become dependent on relatives and friends. At this moment it is important that there is a person next to whom, regardless of everything, will believe in the success of the procedures being carried out.

Often after a skilled care, the victims quickly get to their feet. The most severe cases occur in patients with injuries of the cervical and thoracic spine. In this case, the risk of death from stopping breathing or palpitation is high. If the medical help has been rendered incorrectly or late, then the state of spinal shock can last for years.

Spinal shock is a reversible lesion of the spinal cord, which can imprison the human mind in a motionless body. It all depends on the conditions of injury, the level of defeat and the literacy of care.