Spinal shock is the temporary reduction of or loss of reflexes following a spinal cord injury (SCI). Reflexes -- such as the ability to pull your hand away from a hot stove without thinking -- are controlled by the autonomic nervous system. In general, the more severe the injury, the more severe the autonomic dysfunction will be. However, spinal shock alone cannot be used to determine prognosis or assess the severity of a spinal cord injury.
What Happens After a Spinal Shock?
Just as your body goes into a state of shock after a life-threatening injury, your spinal cord goes into a state of shock after an injury. Almost all people with spinal cord injuries experience some degree of spinal shock, but the severity tends to be greater when the spinal cord is severed, or when it is extremely swollen.
After a spinal shock, the spinal cord enters either hyporeflexia -- a significant reduction in reflexes -- or areflexia -- the temporary loss of reflexes. Because reflexes prevent a number of harms, the temporary loss of these reflexes can be dangerous. More importantly, since most SCI survivors are hospitalized in a safe environment following their injuries, the loss of reflexes signals serious spinal functioning issues.
In the hours immediately following a spinal shock, SCI survivors might not even realize that they are in spinal shock. Other, more urgent injuries are typically a higher priority.
Stages of a Spinal Shock
- One to two days following the injury: Nerve cells become less responsive to sensory input, resulting in full or partial loss of spinal cord reflexes.
- One to three days following injury: Initial return of some reflexes. Polysynaptic reflexes -- those that require a signal to travel from a sensory neuron to a motor neuron -- tend to return first. The delayed plantar reflex, a variation of the normal plantar reflex common among SCI survivors, typically returns first. Next is the bulbocavernosus reflex, which causes the anal sphincter to tighten in response to squeezing the clitoris or head of the penis. Many doctors test for the bulbocavernosus reflex to assess spinal cord injuries.
- One to four weeks following the injury: Hyperreflexia, a pattern of unusually strong reflexes, occurs. This is the result of new nerve synapse growth, and is normally temporary.
- One to twelve months following the injury: Hyperreflexia continues, and spasticity may develop. This process is due to changes in the neuronal cell bodies, and takes much longer than the other stages.
Neurogenic Shock: A Related Condition
In people who suffer spinal cord injuries above thoracic nerves (specifically above T6), neurogenic shock can occur. Neurogenic shock is also due to disruptions in the autonomic system. Because the autonomic nervous system regulates automatic functions such as heart rate, low blood pressure and a slowed heart rate can occur. Left untreated, neurogenic shock can cause organ failure, proving fatal. A variety of drugs, including vasopressin and dopamine, may reduce the effects of neurogenic shock. Assistive respiration devices, heart monitoring, and other tools may also be necessary until neurogenic shock is well-controlled.
Spinal shock and neurogenic shock often co-occur. While spinal shock resolves on its own, neurogenic shock is a medical emergency.
Can Spinal Shock Be Treated?
Spinal shock is to spinal cord injuries as fevers are to infections. Spinal shock is merely a symptom of an underlying problem, not a disease itself. Spinal shock is not typically dangerous, and other symptoms of SCI are far more likely to cause serious, lasting physiological issues.
Consequently, treatment for spinal shock centers around treating the spinal cord injury as a whole. In the immediate aftermath of a spinal cord injury, treatment may include:
- Surgery to remove bone fragments or items lodged in the spinal cord
- Spinal fusion surgery.
- Various brain and spinal cord imaging tests, as well as functional tests such as assessments of reflexes, cognition, and motor skills.
- Antibiotics to treat or prevent infections.
- Assisted respiration.
- Planning for release to a rehabilitation facility.
- Mental health counseling.
Spinal cord injuries vary greatly from person to person, and can change in response to physical therapy. Moreover, it’s difficult to predict the prognosis until swelling diminishes. Thus the early days of treatment center around stabilization, future planning, and adjustment to the shock of an SCI.
Long-Term Prognosis After Spinal Shock
Spinal shock follows a predictable, stereotypical patterns, and no specific treatment is necessary. The presence of spinal shock, however, suggests a serious spinal cord injury -- though the severity of the spinal shock is not a good gauge for either the severity of or the prognosis for the spinal cord injury.
Spinal cord injuries tend to change over time. The more severely compressed the spinal cord is, the less likely full recovery will be. And if the spinal cord is severed, full recovery is extremely unlikely. The location of the injury is also a good indicator of prognosis. The lower the injury is, the less severe the mobility and other impairments will be.
Some people experience a spontaneous recovery after a spinal shock and spinal cord injury. But for most, recovery is directly related to treatment. Long-term treatments for spinal cord injury-related spinal shock include:
- Physical and occupational therapy to help you regain functioning. Therapy acts as a training regimen that helps your body work around its injuries. In some cases, physical therapy can encourage the development of new neurons.
- Medications such as painkillers, antidepressants, or antibiotics.
- Exercise therapy to strengthen the muscles and maintain a healthy body weight.
- Support groups to help you learn from others’ experiences and access helpful resources.
- Psychotherapy to help you develop coping skills for managing your injury and the new life it necessitates.
- Family education about spinal cord injuries.
- Supportive technologies such as an artificial respirator or wheelchair.
- In-home health aides.
The spinal shock you experience immediately following a spinal cord injury often accompanies psychological shock, trauma, and anxiety. But just as spinal shock disappears, so too does the sense of hopelessness that typically accompanies a spinal cord injury. A normal, happy life is still possible.