What is Spinal Shock?
Spinal shock is characterized by the temporary reduction or loss of reflexes following a spinal cord injury (SCI). The spinal cord, bundles of delicate nerves encased within a protective column of vertebrae, serves as the communication superhighway for your brain to transmit signals to the rest of your body. When the spinal cord is injured, there may be a permanent or temporary loss of activity and sensation below the level of the injury.
In general, the more severe the injury, the worse 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 is Spinal Shock Syndrome?
Spinal shock is a clinical syndrome characterized by a combination of various reflex and neurological concerns, including hyporeflexia (the condition of sub-standard or absent reflexes) and autonomic dysfunction. Autonomic dysfunction refers to problems with the autonomic nervous system which controls the ‘automatic’ things your body does such as regulating blood pressure and heart rate.
Stages of Spinal Shock
Spinal shock can be divided into specific stages:
- 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. This is known as hyporeflexia.
- 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.
So, how can you tell whether you have spinal shock? Spinal shock is characterized by a number of symptoms and everyone experiences an SCI differently, which makes it difficult for doctors to differentiate spinal shock symptoms from those that result directly from the spinal cord injury itself.
Symptoms of Spinal Shock
Spinal shock symptoms most often result in changes to:
- Body temperature
- Skin color and moisture
- Perspiration function (decreased or increased sweating, flushing)
- Increased blood pressure and slowed heart rate
- Skeletal muscles
- Sensory response
- Urinary bladder and GI tract functions (overflow and incontinence)
- Vasomotor response
- Depressed genital reflexes
In the first few days following an SCI, doctors will be keeping a close eye on any patient, and looking at whether or not their symptoms are demonstrative of spinal shock, or simply due to the injury itself.
What Causes 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.
How Long Does Spinal Shock Last?
Spinal shock is a short-lived phenomenon, and can be divided into specific, predictable stages. It can start from 30 minutes post-injury, and last up to six weeks. Although spinal shock is characterized by being temporary, it can be permanent in a few cases.
What Happens after a Spinal Shock?
After a spinal shock, the spinal cord enters either hyporeflexia – a significant reduction in reflexes – or areflexia – the temporary loss of reflexes. Because reflexes help to prevent harm, their temporary loss 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.
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. Treatments for spinal cord injury-related spinal shock include:
- Physical and occupational therapies
- Exercise therapy to strengthen muscles and maintain a healthy body weight
- Medications such as painkillers, antibiotics, and antidepressants
- Psychotherapy to aid in coping with and managing the injury
- Family education to help your loved ones understand your injuries
- Use of supportive or assistive technologies, such as a wheelchair or an artificial respirator
- Support groups to help you meet and learn from others’ experiences that can serve as a resource
All patients of spinal cord injury, and spinal shock, will experience it differently. Although there are general symptoms (such as those listed previously), you cannot predict the kind of reaction an individual’s body will take following a spinal cord injury.
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 a SCI.
Prognosis of Spinal Shock
Spinal shock tends to follow predictable, stereotypical patterns – though no specific treatment is deemed necessary above others. The presence of spinal shock, however, suggests a serious spinal cord injury. Yet, it should be noted that 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. 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 to 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 symptoms can disappear, so too can the sense of hopelessness that typically accompanies a spinal cord injury. A normal, happy life is still possible.
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 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.
Living with a spinal cord injury is something that you don’t have to do alone. There are hundreds of thousands of people in the U.S. living with spinal cord injuries. We have an online community of SCI injury survivors and family members you can connect with to discuss your injuries, share experiences, and share helpful coping tips or information.
Written by Zawn VillinesZawn Villines is a writer specializing in health and legal journalism. Raised by a lawyer and lobbyist who advocated for spinal cord injury survivors, she is a lifelong advocate for spinal injury victims and their loved ones. You can connect with Zawn on Google+ below.
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