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 surgery Consultation
VI. References
- (2012) ATLS, ACOS, p. 179-80
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| Definition (CSP) | a loss of spinal reflexes after an injury of the spinal cord which affects the muscles innervated by the cord segments situated below the site of the lesion. |
| Concepts | Injury or Poisoning (T037) |
| Italian | Shock spinale |
| Japanese | 脊髄ショック, ｾｷｽﾞｲｼｮｯｸ |
| English | spinal shock, spinal shock (diagnosis), shock spinal, Spinal shock, shock; spinal, spinal; shock |
| Czech | Míšní šok |
| Hungarian | Spinalis shock |
| Dutch | shock; spinaal, spinaal; shock, spinale shock |
| Portuguese | Choque espinhal |
| Spanish | Parálisis espinal |
| French | Choc spinal |
| German | spinaler Schock |
