II. Pathophysiology
- Temporary (<24 hours) Muscle tone loss (Flaccid Paralysis) and Deep Tendon Reflex loss after Spinal Cord Injury
- Spinal "Shock" is a misnomer as it refers to a "shock" to the spinal nerves, not a true shock syndrome
- Contrast with Neurogenic Shock, which is a Distributive Shock from sympathetic dysfunction
- Incomplete Spinal Cord Injury may mimic complete injury when Spinal Shock is present
III. Signs
-
Bulbocavernosus Reflex (S2-S4) is absent in Spinal Shock and present in severed spinal cord
- Anal sphincter contraction in response to one of following triggers
- Slight traction of Foley Catheter or
- Compressing/Squeezing glans penis or clitoris
- Anal sphincter contraction in response to one of following triggers
- Neurologic function absent below the level of the spinal lesion
- Flaccid Paralysis below the spinal lesion
- Deep Tendon Reflexes absent below the spinal lesion
IV. Precautions: Pitfalls
- Intercostal Muscle paralysis (hypoventilation)
-
Anesthesia below lesion
- Hidden injuries (e.g. Acute Abdomen without pain)
- Transiently shocked spinal cord
- Immobilize immediately
V. Management
- Immobilize spine with Cervical Collar and Backboard with head blocks and all straps
- Frequent ABC evaluation
- Careful secondary Trauma survey
- Emergent Spine SurgeryConsultation
VI. References
- (2012) ATLS, ACOS, p. 179-80