• Monday May 25,2020

Spinal shock

A spinal shock is defined as a condition following a spinal cord lesion with partial or complete transection of the nerve tracts in the body parts below the site of the lesion, so that extrinsic and intrinsic reflexes are completely eliminated. The skeletal muscles as well as the visceromotor autonomic muscles are subject to spinal shock and are completely paralyzed. The duration of the spinal shock is several hours to several months with an average of four to six weeks.

What is a spinal shock?

A spinal shock, which sets in after a spinal cord lesion, is characterized by a complete nervous blockade of certain body regions. It is the body regions whose nervous supply is directly affected by the lesion of the spinal cord. The spinal shock not only paralyzes the voluntary skeletal muscle, but also the involuntary visceromotor musculature.

In addition, sensory sensations and the vegetative control circuits of basic functions such as thermoregulation and the like are overridden. All affected muscles lose their basic tone, their basic tension. The spinal shock differs significantly from the later possibly exhibiting paraplegia.

In a spinal shock - regardless of existing nerve connections or possibly still intact control circuits and sensors - the entire nervous voluntary and involuntary network including the sympathetic and parasympathetic nervous system is completely blocked. It gives the impression that the spinal shock corresponds to a protective mechanism.

This may prevent malfunction or incorrect control loops from forming. The temporary total shutdown allows a later gradual redissolution of the blockade, which corresponds to a gradual and tentative reconnection of certain nerve groups.

causes

Physiologically, a spinal shock is triggered by mass leakage of potassium ions from the cells into the intercellular space. The causes of this mechanism being triggered are usually a lesion of the spinal cord due to an accident. A spinal shock can occur when the spinal cord is completely or partially severed, so that nerve cords are cut off.

Also, a sudden compression of the spinal cord can trigger a spinal shock, although all nerve connections are still mechanically intact - as it turns out later. Accidents involving external agents are not the sole cause of a spinal shock. Tissue proliferation within the spinal canal or at the point of entry and exit of the nerves can result in displacement and eventually crushing of the nerves with loss of function and may trigger a spinal shock.

Similar symptoms may result in a sudden and massive herniated disc. Another tripping problem can arise in the otherwise gentle peridural or spinal anesthesia. In rare cases, there is a shock-like drop in blood pressure, which is probably due to the release of a spinal shock.

Symptoms, complaints & signs

Spinal shock is associated with serious symptoms and discomfort that usually require treatment and care in a trauma room or intensive care unit. The symptoms and signs described below always refer to areas of the body below the level where the spinal cord lesion occurred.

First of all, a complete paralysis with strikingly loose tone can be observed in all affected muscle parts. Because of the absence of sympathetic stimuli, the blood pressure falls sharply and the heart rate is usually slowed down. Symptomatic is an involuntary and uncontrollable discharge of urine and faeces.

The thermo and welding regulation are disturbed. In the short term, the skin feels warm and well supplied with blood because the peripheral vessels are enlarged due to the lack of sympathetic stimuli, which can lead to a rapid loss of heat at low outside temperatures.

Diagnosis & disease course

In most cases, a spinal shock occurs as a result of an accident, so that the first diagnosis is made at the scene of the accident with possibly insufficient aids. A reliable diagnosis of whether a spinal shock is present can only be made after first aid and delivery to the emergency room or intensive care unit.

The course of the spinal shock depends very much on the severity and location of the spinal cord lesion, the initial care and the constitution of the injured person. For minor injuries or a spinal cord compression, the spinal shock can resolve after just a few hours, so that normal body functions are restored.

For severe injuries with later paraplegia, a spinal shock can last up to several months in extreme cases. On average, the shock dissolves after a few weeks.

complications

This disease is a very serious complaint. In most cases no treatment can be carried out if the nerve tracts have already been completely severed. The affected suffer primarily from severe paralysis.

As a rule, they occur directly below the affected level and can make the daily routine of the patient considerably more difficult. This results in restricted mobility, so that most people are dependent on a walker or on a wheelchair. Also, the blood pressure falls through this shock and it comes to a reduced heart rate, so that the affected people can lose consciousness.

Furthermore, even stimuli or reflexes are lost. In many cases, the sufferers also suffer from mental discomfort or depression due to the loss of motion. Since usually no direct treatment of the paralysis is possible, only the remaining symptoms are treated. Special complications do not occur.

However, those affected are also dependent on psychological treatment. Furthermore, no general statement about life expectancy can be made. In general, the further course of the disease also depends heavily on the cause of this shock.

When should you go to the doctor?

In case of such a shock, a doctor must always be consulted immediately. Only a quick and direct treatment of this complaint can prevent further complications. In the worst case, the nerve tracts are completely severed, so that the patient is then completely paraplegic.

The doctor should then be contacted if there is severe paralysis of the muscles in different parts of the body. These paralyzes usually affect the body regions below the hip, so that the affected person can no longer move his legs. The muscles go limp and can no longer be moved. In many cases, severe or even uncontrolled urgency may indicate this shock. Furthermore, some sufferers also show an uncontrolled sweat production. If these symptoms occur, the doctor in the hospital must be contacted immediately.

Treatment & Therapy

The treatment of spinal shock is initially confined to emergency care, taking into account the other injuries, especially spinal cord injuries. Primary or emergency care aims to maintain or regain vital functions such as breathing and circulation. In addition, heat regulation plays a major role.

It must be ensured that the heat loss is minimized by a special ceiling or even heat is supplied to keep the body temperature in an acceptable range above 35 degrees Celsius as possible. Further treatment usually targets the diagnosed injuries. A direct drug or other therapy for the rapid resolution of the spinal shock is not known.

prevention

Direct preventative measures to prevent a spinal shock are nonexistent. Indirect preventative protection is to avoid risky sports and other spine injury risk situations. Regular light sports with back exercises largely develop disc problems. Nevertheless, there are residual risks that can not be completely avoided and can be assigned to the general life risk.

aftercare

The spinal shock is caused by violence on the spine. Symptoms include paralysis, immobility, respiratory distress, and limited activity of the internal organs. This condition must be taken seriously in any case. He requires immediate medical care. Aftercare is necessary to avoid permanent damage.

Mostly the spinal cord is damaged by an accident. A 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 paraplegia be determined. As long as the patient is receiving medical care in the hospital. The aftercare already begins during the hospital stay.

Consequential damage can be better controlled with early therapy. The muscle reflexes gradually return. With a favorable course of the spinal shock heals without consequences. A slight contusion of the spinal cord does not cause any delayed effects. The patient is discharged from the clinic. He should nevertheless carry out regular checks by a neurologist.

In severe cases permanent damage to the spine remains. Aftercare takes a lifetime for paraplegia. In doing so, the person concerned learns appropriate handling of the paralysis. There is no universal treatment. It is different for each patient. The orthopedist adapts them individually.

You can do that yourself

In a spinal shock, the possibilities of self-help for the person concerned are very low. Primarily it is about strengthening the psyche and optimizing the inner attitude for dealing with the disease. Self-help approaches are very limited as there are no treatment methods outside of medical care that will improve the state of health. The mental support is therefore particularly important.

Preventive exercises can be performed regularly to support the skeletal system and the muscular system. Therapeutic exercises for stabilization and a timely response to a heavy physical strain are particularly helpful. Conditions of overexertion should therefore be avoided.

However, as soon as the disease has been diagnosed, the person has little opportunity to control his own body. The paralysis and the loss of movement prevent him from performing sufficient activities. If the muscles in some areas of the body can be moved, this should be exercised regularly. Learned training units can also be carried out on their own responsibility outside of a therapy.

It is important to have a positive basic attitude towards life and the belief that improvements are possible despite all adversities. The state of shock is an emergency situation. Trust in the attending physician is especially important at this time. They should work together as closely as possible.


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