Spinal cord concussion or commotio spinalis is the mildest stage of spinal cord injury and occurs, for example, in the context of accidents. Unlike the more severe forms, no spinal cord lesion can be detected on radiologic examination in commotio spinalis. Complaints such as micturition disorders or reflex deficits resolve on their own about 48 hours after the incident.
What is commotio spinalis?
The spinal cord is part of the central nervous system and, with its pyramidal tracts, plays an important role in controlling human movement. Spinal cord trauma is damage or injury to the spinal cord or its surrounding area that is often associated with impaired movement control. Generally, spinal cord injuries are divided into three different stages that vary in severity. In addition to spinal cord contusion (Compressio spinalis), there is spinal cord contusion (Contusio spinalis). The mildest stage of spinal cord injury is spinal cord concussion, also known as commotio spinalis. Unlike the other stages, this stage of spinal cord injury is characterized by only transiently predominant deficits in neurologic transmission of stimuli due to the application of mechanical force.
Causes
Commotio spinalis has as its cause a physically mechanical application of force to the spine. In most cases, spinal cord concussion is caused by short-term and indirect force on the spinal canal of the spinal cord. This type of force can occur, for example, in a car accident, an accident at work or a sports accident. The decisive factor is the time limit of the force impact. Prolonged or direct force to the spinal cord is more likely to result in a spinal cord contusion or spinal cord bruise than a spinal cord concussion. Unlike the other two stages, spinal cord concussion does not demonstrate manifest injury to the spinal cord by radiologic means. In other words, the brief exposure to force has not left any demonstrable traces, but can only be suspected on the basis of the symptoms.
Symptoms, complaints, and signs
The exact symptomatology of commotio spinalis depends on the one hand on the severity and on the other hand on the exact localization of the violent impact. Mild violent impacts lead symptomatically to sensory disturbances, so preferentially in the extremities. Medium-grade violence can be accompanied by a disturbance of reflex function or micturition disorders, while severe violence to certain areas of the spinal cord can also lead to manifest paralysis of the extremities. In distinction to spinal cord contusion and spinal cord bruise, all symptoms of spinal cord concussion subside on their own after 48 hours at the latest. In most cases, affected individuals suffer at most mild pain. Sufferers often present with other trauma, as commotio spinalis is usually the result of an accident.
Diagnosis and course
The diagnosis of commotio spinalis is made by a neurologist. It is important in the diagnosis to differentiate it from other stages of spinal cord injury. In addition to taking a history, the neurologist performs a reflex examination. The failure of reflex physiological movements may indicate a spinal cord injury. The same is true for reflex pathological movements with an appropriate history. Differentiation of commotio spinalis from other spinal cord injuries is accomplished exclusively by imaging. A radiologically visible spinal cord injury is not commotio spinalis. If the spinal cord appears intact radiologically but reflex deficits or similar symptoms are still present, the diagnosis of spinal cord concussion is obvious. The prognosis for patients with spinal cord concussion is favorable. Irreversible damage does not occur.
Complications
In most cases, commotio spinalis results in loss of reflexes and paralysis. These usually do not occur immediately but with a time delay after the accident. Commotio spinalis causes relatively severe sensory disturbances. These can occur in different parts of the body and thus relatively severely restrict the movement and generally the everyday life of the affected person.The extremities may become paralyzed, making the affected person dependent on a walker or wheelchair. It is not uncommon for pain to occur as well. However, the symptoms of commotio spinalis do not last permanently, but disappear in most cases after a few days, so that there are no permanent complications or restrictions. Complications can occur mainly as a result of the accident. If the symptoms and pain of commotio spinalis do not disappear on their own, treatment with painkillers or therapies is necessary. This usually leads to success and further complications do not occur. It is not uncommon, however, for patients to require psychological care after the accident in order to cope with the accident itself and the consequences of it.
When should one go to the doctor?
In most cases, this complaint does not require special medical treatment. However, complaints of this doctor should be examined by a doctor, especially after an accident, to avoid further complications and possibly permanent paralysis. A doctor should be consulted if there are disturbances in sensitivity or various paralyses on the patient’s body. These can occur in different regions. The reflexes of the affected person are also negatively affected and can be significantly restricted. A medical examination is especially necessary if these symptoms do not subside on their own within 48 hours. Usually, the disease can be detected during a radiological examination. In the first instance, however, a visit to a general practitioner is necessary. If the complaints and symptoms disappear again on their own, usually no special treatment of this disease is necessary and a positive course of the disease occurs.
Treatment and therapy
Spinal cord concussion requires, first of all, sparing. The patient ideally keeps quiet and enjoys bed rest for the next few days. Because symptoms resolve after two days, no further treatment is usually required. This relationship distinguishes spinal cord concussion from other stages of spinal cord injury. Since the patient may also suffer from more or less severe pain in the case of a commotio spinalis, conservative medical treatment with painkillers may be considered in addition to therapeutic sparing. However, this procedure is only indicated if the pain is actually severe and the patient’s quality of life is clearly impaired by the pain symptoms for the next few days. Mild pain can generally be a good indicator of the prevalence and resolution of concussion. Once the mild pain has subsided, this gives an indication that the patient has fully recovered. Reflex examination should be repeated after 48 hours. If pathologic reflex behavior is still present, further imaging may be indicated. In rare cases, more severe spinal cord injuries do not show up on initial imaging and do not develop to their true extent until the days following exposure to violence. If imaging after 48 hours still does not indicate an actual manifest spinal cord injury, but neurologic deficits have persisted, a psychosomatic cause may be present. In this case, the patient is instructed to seek psychotherapeutic care to cope with the accident situation and its consequences.
Outlook and prognosis
Commotio spinalis has a favorable prognosis. The symptoms are not permanent and gradually subside within a few days. The person’s self-healing powers become active and relieve the symptoms without further intervention by a physician. Depending on the severity of the damage, the healing process can last for one to two weeks. Afterwards, the patient is normally free of symptoms. As soon as the patient follows the doctor’s instructions and advice, he or she will notice a marked improvement in his or her well-being after just 48 hours. Permanent impairments are not to be expected with commotio spinalis. Consequential symptoms also occur only in very rare cases. They are usually due to further exposure to violence or disregard of the doctor’s instructions. The patient needs a few days of rest and recuperation to heal.If further intensive physical activities occur during this time, the health may deteriorate and the complaints increase. Vibration in particular should be avoided to maintain a good prognosis. If the patient suffers from a secondary symptom, it is usually linked to the cause of the violent or forceful event. Sleep disturbances, nightmares, trauma, or an anxiety disorder may develop as a result of the triggering event.
Prevention
Commotio spinalis can be prevented only to the extent that violence to the spinal cord can be prevented. Because accidents can never be completely ruled out, preventive measures are limited. Nevertheless, studies show that a trained back is more likely to be able to cope with violent impacts without injury than an untrained back. For this reason, back training or attending a back school may make sense as a preventive measure related to commotio spinalis. For example, those who have problems with their spinal discs are all the more susceptible to spinal cord concussions or even the more severe stages of spinal cord injury in an accident situation. For this reason, to the greatest extent possible, all efforts to improve back health are considered preventative measures for spinal cord injuries.
Here’s what you can do yourself
Self-help measures for healing can be limited for spinal cord concussion. Therefore, self-help for this condition is aimed at a supportive influence in the recovery process. Sufficient rest, sparing and only a low load on the back help to alleviate the symptoms as quickly as possible. Conditions during nighttime sleep should be critically examined and optimized if necessary. The back needs a healthy sleeping position to promote the healing process. Jerky movements of the upper body should always be avoided. Likewise, the body should not be subjected to jolting by hopping, jumping or running. Slow and steady movements are recommended. With regard to posture, care should be taken to ensure that there is no crooked posture or incorrect one-sided strain. This places unnecessary stress on the skeletal system and can affect the supply of muscles, nerves or tendons. When engaging in recreational activities and playing sports, check to see if they are beneficial during the recovery process. Visiting amusement park rides is not recommended, nor is participation in ball sports or a fitness workout. Exercises or environments that promote relaxation are helpful. This strengthens the well-being and prevents the back from being subjected to unnecessary stress. Additionally, a healthy diet can support the immune system.
