Spinal shock is defined as a condition that occurs after a spinal cord lesion with partial or complete severance of the nerve tracts in the parts of the body below the site of the lesion, such that even external and intrinsic reflexes are completely shut down. The skeletal musculature and also the visceromotor autonomic musculature undergo spinal shock and are completely paralyzed. The duration of spinal shock ranges from several hours to several months with a mean of four to six weeks.
What is spinal shock?
Spinal shock, which occurs after a spinal cord lesion, is characterized by complete nervous blockade of specific body regions. These are the body regions whose nervous supply is directly affected by the spinal cord lesion. Spinal shock paralyzes not only the voluntary skeletal muscles but also the involuntary visceromotor muscles. In addition, sensory perception and the autonomic control circuits of basic functions such as thermoregulation and the like are disabled. All affected musculature loses its basic tone, its basic tension. Spinal shock is clearly different from paraplegia, which may appear later. In spinal shock, the entire nervous voluntary and involuntary network, including the sympathetic and parasympathetic nervous systems, is completely blocked, regardless of any remaining nerve connections or possibly still intact control circuits and sensory systems. The impression suggests itself that the spinal shock corresponds to a protective mechanism. Possibly, this prevents the formation of erroneous reactions or wrongly reacting control circuits. The temporary total shutdown allows a later gradual reopening of the blockade, corresponding to a gradual and tentative reconnection of certain nerve groups.
Causes
Physiologically, spinal shock is triggered by a mass leakage of potassium ions from cells into the intercellular space. The causes for this mechanism to be initiated are usually due to a lesion of the spinal cord by accident. Spinal shock can occur when the spinal cord is completely or partially severed, cutting nerve conduits. A sudden compression of the spinal cord can also cause spinal shock, even though all nerve connections are still mechanically intact-as may be revealed later. Accidents involving external agents are not the sole culprits of spinal shock. Tissue growths within the spinal canal or at the site of nerve entry and exit can cause displacement and ultimately crushing of the nerves with loss of function, possibly causing spinal shock. Similar symptomatology may result from a sudden and massive disc herniation. Another triggering problem may arise with otherwise gentle peridural or spinal anesthesia. In rare cases, shock-like hypotension occurs, likely due to triggering of spinal shock.
Symptoms, complaints, and signs
Spinal shock is associated with serious symptoms and symptoms that usually require treatment and care in a shock room or intensive care unit. The symptoms and signs described below always refer to body regions below the level at which the spinal cord lesion occurred. Initially, complete paralysis with striking flaccid tone can be seen in all affected muscle areas. Because of the failure of sympathetic stimuli, blood pressure drops sharply and the heart rate is usually slowed. Symptomatic is involuntary and uncontrollable urination and defecation. Thermoregulation and perspiration are disturbed. In the short term, the skin feels warm and well perfused because the peripheral vessels dilate due to the lack of sympathetic stimuli, which can cause rapid heat loss at low outdoor temperatures.
Diagnosis and course of the disease
In most cases, spinal shock occurs because of an accident, so the initial diagnosis is made while the patient is still at the scene of the accident with possibly inadequate resources. A robust diagnosis of whether spinal shock is present can only be made after initial care and admission to the shock room or intensive care unit.The course of spinal shock depends very much on the severity and location of the spinal cord lesion, on the initial treatment and on the constitution of the injured person. In more minor injuries or in spinal cord sprain, spinal shock may resolve after only a few hours, allowing normal body functions to resume. In more serious injuries with subsequent paraplegia, spinal shock can last up to several months in extreme cases. On average, the shock resolves after a few weeks.
Complications
This condition is a very serious complaint. In most cases, no treatment can be carried out if the nerve tracts have already been completely severed. Those affected suffer primarily from severe paralysis. They usually occur directly below the affected level and can make the patient’s everyday life considerably more difficult. This results in restricted movement, so that most of those affected are dependent on a walking aid or a wheelchair. Blood pressure also drops as a result of this shock and there is a reduced heart rate, so that the affected person can lose consciousness. Furthermore, stimuli or reflexes are also lost. In many cases, those affected also suffer from psychological discomfort or depression due to the loss of movement. Since there is usually no direct treatment for the paralysis, only the remaining symptoms are treated. No particular complications occur. However, those affected are also dependent on psychological treatment. Furthermore, no general statement can be made about life expectancy. As a rule, the further course of the disease also depends strongly on the cause of this shock.
When should one go to the doctor?
In the event of such a shock, a doctor must always be consulted immediately. Only by treating this complaint quickly and directly can further complications be prevented. In the worst case, the nerve tracts are completely severed, leaving the patient completely paraplegic afterwards. The doctor should be contacted if there is severe paralysis of the muscles in different parts of the body. These paralyses usually affect the body regions below the hip, so that the affected person can no longer move his legs. The muscles slacken and can no longer be moved. In many cases, a strong or even uncontrolled urge to urinate can also indicate this shock. Furthermore, some affected persons also show an uncontrolled sweat production. If these symptoms occur, the doctor to be treated in the hospital must be contacted immediately.
Treatment and therapy
Treatment of spinal shock is initially limited to emergency care with consideration of other injuries, especially spinal cord injuries. Initial or emergency care is aimed at preservation or recovery of vital functions such as respiration and circulation. In addition, thermoregulation plays a major role. Care must be taken to minimize heat loss by means of a special blanket or even to supply heat in order to keep the body temperature as far as possible within a still acceptable range above 35 degrees Celsius. Further treatment is usually based on the injuries diagnosed. There is no known direct drug therapy or other therapy for rapid resolution of spinal shock.
Prevention
Direct preventive measures to avoid spinal shock are nonexistent. Indirect preventive protection consists of avoiding high-risk sports and other situations with risk of injury to the spine. Regular light sports with back exercises prevent spinal disc problems as far as possible. Nevertheless, there remain residual risks that cannot be completely avoided and can be assigned to the general risk of life.
Aftercare
Spinal shock results from force applied to the spine. Characteristic symptoms include paralysis, immobility, respiratory distress, and impaired activity of the internal organs. This condition must be taken seriously in any case. It requires immediate medical attention. Follow-up care is necessary to prevent permanent damage. Most often, the spinal cord is damaged by an accident. Spinal shock occurs about an hour after the injury. It lasts from a few days to six weeks.Only after this period can the severity of the paraplegia be determined. During this time, the patient receives medical care in the hospital. Follow-up care already begins during the hospital stay. Consequential damage can be combated more effectively with early therapy. Muscle reflexes gradually return. If the course is favorable, spinal shock heals without consequences. A slight contusion of the spinal cord does not result in any late sequelae. The patient is discharged from the hospital. However, regular check-ups by a neurologist are recommended. In severe cases, permanent damage to the spine remains. Aftercare for paraplegia lasts a lifetime. During this time, the affected person learns how to deal with the paralysis appropriately. There is no generally valid treatment. It is different for each patient. The orthopedist adapts it individually.
What you can do yourself
In spinal shock, the options for self-help for the affected person are very limited. Primarily, it is about strengthening the psyche and optimizing the inner attitude for dealing with the disease. The approaches of self-help are very limited, because there are no treatment methods outside of a medical care that allow an improvement of the health condition. Mental support is therefore particularly important. As a preventive measure, regular exercises can be performed to support the skeletal system as well as the muscular system. Therapeutic exercises for stabilization and timely reaction in case of a strong physical stress are especially helpful. States of overexertion should therefore be avoided. However, once the disease has been diagnosed, the affected person has little ability to control his or her own body. The paralysis and loss of movement prevent him from performing adequate activities. As long as the muscles in some areas of the body can be moved, they should be exercised regularly. Learned training units can also be performed independently outside of therapy. It is important to have a positive attitude towards life and to believe that improvements are possible despite all adversities. The state of shock represents an emergency situation. Trust in the attending physicians is especially important at this time. The closest possible cooperation should be maintained with them.
