Spinal shock is a phenomenon in neurology that is caused by a traumatic effect on the spinal column with damage to the spinal cord. It is expressed in the sharp inhibition of all reflex centers located in the spinal cord below the site of injury. Artificial induction of reflexes above the affected area shows that innervation is maintained there. As a result, there is a decrease in blood pressure, lack of dermographism, as well as disruption of the pelvic organs.
Development mechanism
A 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 spinal fracture, since spinal cord damage will be not only at the site of the injury, but also in areas where blood circulation and lymph flow are impaired. It is this area that can be restored over time.
Nature provides a mechanism that protects tissues from greater damage. It lies in the fact that the activity of nerve cells is inhibited below the site of injury, thus, the affected area is at rest and faster restored. The transmission of nerve impulses along the conduction paths ceases during regeneration.
Diagnostics
Immediately after the injury, it is impossible to determine whether the lesion of the spinal cord is of an anatomical or functional nature. Spinal shock is characterized by reversibility of processes and full or partial restoration of function. The level of spinal injury forms a certain symptom complex, which makes it possible to diagnose the exact location of the lesion. To do this, you need to identify the lowest part of the spinal cord, responsible for normal innervation. This may take some time, but a general neurological examination will indicate the approximate area of damage.
After this, it is necessary to send the patient for neuroimaging (CT or MRI) in order to accurately know the condition of the segments of interest to the doctor.
Determination of sensitivity and motor activity
To determine the degree and level of damage, a neurologist evaluates 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 reaction.
Muscles are examined symmetrically and in turn from the trunk to the limbs. All results are summarized, and the average total score, separate for sensitivity and for the motor sphere, is displayed. The examination must be carried out several times during the entire period of the patient’s stay in the hospital in order to dynamically monitor the restoration of functions. For example, if a month after the start of treatment, the patient’s total assessment of the motor function of the lower extremities will be above fifteen points, that by the end of the year he will most likely be able to walk.
Lesion levels
Signs of spinal shock directly depend on the level of damage.
If the injury was at the level of the cervical vertebrae, then this leads to immobilization of the upper and lower extremities. The function of respiration and palpitations is inhibited. Patients are forced to be on a ventilator and should be constantly cared for.
A lesion at the level of the lower segments of the cervical spine keeps normal upper limb function. But if this also affects the thoracic vertebrae, then the patient still has problems with breathing and heart rhythm. Damage at the navel level causes spinal shock with immobilization of the muscles of the back and lower extremities, and also disrupts the functioning of the pelvic organs as a delay.
The most favorable option is considered a spinal cord injury at the level of the lumbosacral segment. In this case, spinal shock only causes impaired movement in the lower extremities while maintaining some of the sensitivity.
Disease periods
The disease is partially or completely reversible in nature, so a few months after the injury, patients feel better, the lost functions return to them. Four stages of spinal shock are distinguished.
1. An acute period that lasts the first three days after an injury. It is characterized by the complete absence of nerve impulses below the damage, regardless of the severity of the damage.
2. The subacute period takes about a month. At this time, the damaged structures of the spinal cord are restored, scar tissue appears at the site of the injury, 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 impulse ceases, only irreversible neurological changes prevail in the clinic.
4. Late period, which may continue several years after injury. This is a time of slow recovery of lost functions. But along with the likelihood of positive dynamics, it is also possible scarring of the substance of the spinal cord at the site of injury and aggravation of neurological 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 lost functions will not be restored. And vice versa, if in the first week at least some shifts occurred, then the probability of a full recovery is high.
Disease duration
Not only people have spinal shock. Physiology, in the broad sense of the word, proves that in animals this condition is also possible. For example, in a frog it lasts up to five minutes, in dogs - about a week, monkeys are forced to endure inconvenience for a month. People on this list are in the very last position. They have the greatest duration of spinal shock - two months.
If after an injury the spinal cord remains anatomically intact, then after some time the reflexes are restored. It all depends on how the patient is disposed to treatment and has faith in himself.
Therapeutic tactics
The sooner the victim enters a medical institution, where they can be provided with qualified help, the more likely they are to recover. In addition, first aid and transportation are of great importance. The patient must be moved carefully, transferred only on a hard board or shield, so as not to aggravate the damage.
They begin to treat spinal shock competently with immobilization of the spine. Then, a series of surgical interventions are performed to decompress the spinal cord, remove fragments of the vertebrae, necrotic tissue and foreign bodies. After this, the surgeon makes plastic surgery of the lost bone formations.
Conservative therapy consists in the use of glucocorticosteroids, such as Dexamethasone or Prednisolone, and centrally acting muscle relaxants - Midokalm, Sirdalud, Baclofen. The first relieve pain symptoms, swelling, reduce inflammation. And the second ones help to remove the load on the spinal column.
Since the patient will be immobilized for a long time, he needs the prevention of pressure sores, massages, gymnastics and breathing exercises to prevent pneumonia.
Chance of recovery
Complete immobility negatively affects the psyche of patients. People morally prepare themselves for the fact that they will be confined to a bed or a wheelchair for life and will become dependent on relatives and friends. At this moment, it is important that there is a person nearby who, in spite of everything, will believe in the success of the procedures.
Often after qualified assistance, victims quickly get to their feet. The most severe cases occur in patients with injuries of the cervical and thoracic spine. In this case, there is a high risk of death from respiratory arrest or palpitations. If medical care was provided incorrectly or later, then the state of spinal shock can last for years.
Spinal shock is a reversible lesion of the spinal cord that can enclose the human mind in a motionless body. It all depends on the conditions of injury, the level of damage and the literacy of care.