Spinal shock is a phenomenon in neurology, which is caused by a traumatic effect on the spinal column with damage to the spinal cord. It is expressed in a sharp inhibition of all reflex centers located in the spinal cord below the site of injury. Artificial evoking of reflexes above the affected area shows that innervation is preserved there. As a result, there is a decrease in blood pressure, the absence 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 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 be not only at the site of 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 more damage. It lies in the fact that the activity of nerve cells is inhibited below the site of injury, thus, the affectedthe site is at rest and recovers faster. The transmission of nerve impulses along the pathways stops for the duration of regeneration.
Diagnosis
Immediately after an injury, it is impossible to determine whether the spinal cord lesion 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, which is responsible for normal innervation. This may take some time, but a general neurological examination will indicate the approximate area of the lesion.
After that, it is necessary to send the patient for neuroimaging (CT or MRI) in order to accurately find out the condition of the segments of interest to the doctor.
Determination of sensitivity and physical activity
To determine the degree and level of damage, the neuropathologist 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 summed up and the average total score is displayed, separate for sensitivity and for the motor sphere. The examination must be carried out several times during the entire period of the patient's stay in the hospital.in a hospital to monitor the restoration of functions in dynamics. For example, if one month after the start of treatment, the patient's total assessment of the motor function of the lower extremities is above fifteen points, then by the end of the year he will most likely be able to walk.
Levels of defeat
Signs of spinal shock directly depend on the level of the lesion.
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 heartbeat is inhibited. Patients are forced to be on a ventilator and must be constantly cared for.
Loss at the level of the lower segments of the cervical spine maintains the normal functioning of the upper limbs. But if the thoracic vertebrae are also affected, then the patient still has problems with breathing and heart rhythm. Damage at the level of the navel causes spinal shock with immobilization of the muscles of the back and lower extremities, and also disrupts the functioning of the pelvic organs by the type of delay.
The most favorable option is spinal cord injury at the level of the lumbosacral segment. Spinal shock in this case causes only a violation of movements in the lower extremities while maintaining part of the sensitivity.
Periods of disease
The disease is partially or completely reversible, so a few months after the injury, patients feel better, their lost functions return. There are four stages of spinal shock.
1. The acute period, which lasts the first three days after the injury. It is characterized by the complete absence of nerve impulse conduction below the injury, regardless of the severity of the injury.
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 injury, blood circulation and lymph flow normalize.
3. The interim period can last up to six months. At this stage, the central inhibition of nerve impulses stops, only irreversible neurological changes prevail in the clinic.
4. Late period, which may last several years after the injury. This is a time of slow recovery of lost functions. But along with the likelihood of positive dynamics, scarring of the substance of the spinal cord at the site of injury and aggravation of neurological symptoms are also possible.
It is good for clinicians and patients to remember that a complete lack of improvement in the first week is a poor prognostic sign and may indicate that lost function will not be restored. And vice versa, if at least some changes occurred in the first week, then there is a high probability of a complete recovery.
Duration of illness
It's not just people who get spinal shock. Physiology, in the broad sense of the word, proves that such a state is also possible in animals. For example, in a frog it lasts up to five minutes, in dogs it lasts about a week, monkeys have to endure inconvenience for a month. People on this listare in the last position. They have the longest duration of spinal shock at two months.
If after an injury the spinal cord remains anatomically intact, then after a while the reflexes are restored. It all depends on how the patient is disposed towards treatment and has faith in himself.
Treatment tactics
The sooner the victim gets to a medical institution, where he can be provided with qualified assistance, the more likely he is to recover. In addition, first aid and transportation are of great importance. It is necessary to shift the patient carefully, transfer only on a hard board or shield, so as not to aggravate the damage.
To treat spinal shock competently begins with immobilization of the spine. Then a number of surgical interventions are performed to decompress the spinal cord, remove vertebral fragments, necrotic tissues and foreign bodies. After that, the surgeon makes a 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 - Mydocalm, Sirdalud, Baclofen. The former relieve pain symptoms, swelling, and reduce inflammation. And the latter help relieve the load on the spinal column.
Since the patient will be immobilized for a long time, he needs pressure sore prevention, massages, gymnastics and breathing exercises to prevent pneumonia.
Chance forrecovery
Complete immobility has a negative effect on the psyche of patients. People mentally prepare themselves for the fact that for the rest of their lives they will be chained to a bed or a wheelchair and 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, the victims quickly get on their feet. The most severe cases occur in patients with injuries to the cervical and thoracic spine. In this case, the risk of death from respiratory arrest or heartbeat is high. If medical care was provided incorrectly or too late, then the state of spinal shock can continue for years.
Spinal shock is a reversible injury to the spinal cord that can trap a person's mind in an immobile body. It all depends on the conditions of injury, the level of damage and the literacy of assistance.
