If you or a loved one has recently suffered a spinal cord injury (SCI), you may be hearing a lot of unfamiliar terms from doctors. One medical term that many people only hear about after suffering an SCI is "spinal shock." What shock in this context? More importantly, how can this medical condition be treated?
Spinal shock is characterized by the temporary reduction or loss of reflexes following a spinal cord injury. The spinal cord, which is comprised of 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 your medical prognosis or assess the severity of a spinal cord injury.
Spinal shock syndrome is really 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 maintaining your blood pressure and heart rate.
Spinal shock is closely related to another form of shock called neurogenic shock. Both conditions have similar causes, but have different effects. As noted in a ScienceDirect topic page, “Neurogenic shock describes the hemodynamic changes resulting from a sudden loss of autonomic tone due to spinal cord injury. Spinal shock, on the other hand, refers to a loss of all sensation below the level of injury and is not circulatory in nature.”
Understanding the pathophysiology – defined by Merriam-Webster as “the functional changes that accompany a particular syndrome or disease” – in spinal shock cases can be aided by understanding the anatomy of the spinal cord.
The spinal cord and its nerve bundles can be broken down into four major sections:
Damage to different levels of the spinal cord will have different effects. Generally speaking, the higher up on the spinal cord an injury (i.e., the closer to the brain it is), the worse the effects will be.
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.
According to research by Dr. Dittuno of Thomas Jefferson University, there are four stages to spinal shock. Early stages often begin with patients experiencing an “anaesthetized feeling” of the body below the injury, however this can be tricky to determine as only a day following injury, the extent of injury is still being assessed – and the application of actual anesthesia during treatment immediately after an injury can further confuse the early stages of spinal shock.
So, how can you tell whether you have spinal shock? Spinal shock is characterized by a variety of symptoms and everyone experiences their SCI differently. This fact makes it difficult for doctors to differentiate spinal shock symptoms from those that result directly from the spinal cord injury itself.
Below is a list of some symptoms that may accompany the different stages of spinal shock. Of course, it can be challenging for doctors to determine whether or not they are looking to treat spinal shock or if they’re looking at issues created directly from the spinal cord injury. Spinal shock is characterized by:
All patients of spinal cord injury, and spinal shock, will experience it differently. Although there are general symptoms (such as those listed above), you cannot predict the kind of reaction an individual’s body will take following a spinal cord injury.
In the first few days following an SCI, doctors will be keeping a close eye on the patient so they can evaluate if any symptoms are demonstrative of spinal shock or are due to the injury itself. Spinal shock death is rare, and most deaths among spinal shock patients is caused by the original injury rather than the condition.
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.
A “differential diagnosis” is a list of possible conditions that may be causing the specific symptoms that a person is experiencing. Doctors may provide their patients with a list of differential diagnoses for a condition based on things like:
Doctors may try to identify differential diagnoses by performing some tests in controlled conditions. This way, they can verify if there are specific triggers for symptoms that are more in line with a differential diagnosis other than spinal shock.
Some examples of differential diagnoses for spinal shock symptoms include:
This is just a small sample of the differential diagnoses that share one or more symptoms with spinal shock—there are many more conditions than could be listed in a short article.
In many cases, the identification of spinal shock as a separate condition from other potential diagnoses is based on a close examination of the patient and taking into account when the symptoms appeared—such as them only appearing within a day of the patient being in a major auto accident or suffering a slip and fall incident.
Spinal shock is a short-lived phenomenon, and can be divided into specific, predictable stages. It can start roughly 30 minutes after an injury, and last six weeks (though spinal shock duration can vary from this in some cases).
While spinal shock is typically characterized by being temporary, it can be permanent in a few cases. This may be why some people think that spinal shock is a permanent loss of some of the spinal cord’s functions rather than a temporary condition (permanent loss is usually caused by an SCI or brain injury).
It can be difficult for some spinal shock patients to know exactly when their condition is “over” and they can be considered as fully recovered as they can be. In some cases, spinal shock signs and symptoms never fully go away.
Generally speaking, a doctor should be the one to provide the official “all clear” to let a patient know that their condition is over. However, different doctors/physicians may use different criteria to judge that the condition has ended.
According to a study featured on the U.S. National Library of Medicine National Institutes of Health, “Some clinicians interpret spinal shock as ending with the appearance of the bulbocavernosus reflex… Others state that spinal shock ends with the recovery of deep tendon reflexes.”
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:
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 tends to focus on treating the spinal cord injury as a whole. In the immediate aftermath of a spinal cord injury, treatment may include:
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.
The complications of spinal shock can be similar to SCI complications since SCIs are a common cause of spinal shock – spinal shock itself is listed as a complication of SCI. Some complications that can arise from spinal shock include:
Spinal shock tends to follow predictable 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 or the prognosis of 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.
In people who suffer spinal cord injuries above their thoracic nerves (specifically above the T6 nerve), neurogenic shock can occur. Neurogenic shock can also be caused by 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.