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Spinal Shock
There is little room for swelling within the structural confines of the vertebral canal and the
oedematous spinal cord is quickly compressed against the surrounding bone. Circulation of
blood and oxygen within the spinal cord is disrupted and ischaemic tissue necrosis quickly
follows. There is an almost immediate cessation of conductivity within the spinal cord
neurons. This is termed ‘spinal shock’.
Neurologically, at this time, the patient presents with the loss of all voluntary movement and
sensation below the level of the injury. There is also a progressive loss of sympathetic and
parasympathetic activity throughout the same area. At this stage, it is difficult to be certain
of the extent or permanence of functional loss within the spinal cord neurons.
The presence of paralysis or paraesthesia does not imply any finality to the process.
In some instances, spinal cord oedema and spinal shock can resolve over time with a
subsequent improvement in neurological function.18
Spinal shock usually persists for between 2 and 6 weeks dependent on the age of the
casualty and the extent of accompanying trauma. During this time, it is impossible for the
clinician to provide an accurate diagnosis of the extent of permanent loss of function.18
After SCI the loss of all voluntary movement and sensation below the level of the lesion is
probably familiar to most professionals in non-specialist areas. Less common, however, is
an awareness and appreciation of the effects of spinal shock on the internal systems of
the body, especially its effects on autonomic and reflex functions. The management of
the effects of spinal shock within each individual body system are described later.
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Key point The presence of spinal cord paralysis on admission does not imply any finality to the
process of lesion formation or give any indication of the potential for permanent loss of
function.
Paraplegia/Paraparesis:
This term is used to describe the complete or partial loss of all movements and/or sensation
from the chest downwards, affecting only the lower limbs.
The term ‘complete spinal cord lesion’ is used to define the diagnosis of transverse
(complete) ischaemic necrosis, which results in the permanent loss of all voluntary
movements and sensation below the level of the lesion. However, the process by which
spinal cord oedema occurs and progresses towards ischaemia is unique in each case.
There is always the potential at this stage that the oedema will resolve with the subsequent
return of some neurological function, as a result of the ability of some nerve fibres to
survive. Where this occurs, a diagnosis of ‘incomplete spinal cord lesion’ is given.19
18
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C4
Injury
TETRAPLEGIA
Results in Cervical vertebrae
complete (neck) SPINAL
paralysis below CORD
the neck
C6
Injury
TETRAPLEGIA
Results in partial Thoracic
paralysis of hands vertebrae
and arms as well (attached to ribs)
as lower body
T4
Injury
PARAPLEGIA
Results in
paralysis below
the chest
L1 Lumbar
vertebrae
Injury
PARAPLEGIA (lower back)
Results in
Illustrations by Claire Macdonald / SIA
paralysis below
the waist Sacral
vertebrae
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Incomplete Spinal Cord Lesions
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