Spinal Shock

1. See Also
   1. Neurogenic Shock
   2. Spinal Cord Syndrome
   3. Cervical Spine Injury
   4. Thoracolumbar Trauma
2. Pathophysiology
   1. Temporary (<24 hours) Muscle tone loss (Flaccid Paralysis) and Deep Tendon Reflex loss after spinal cord injury
   2. Spinal "Shock" is a misnomer as it refers to a "shock" to the spinal nerves, not a true shock syndrome
      1. Contrast with Neurogenic Shock, which is a Distributive Shock from sympathetic dysfunction
   3. Incomplete spinal cord injury may mimic complete injury when Spinal Shock is present
3. Signs
   1. Bulbocavernosus Reflex (S2-S4) is absent in Spinal Shock and present in severed spinal cord
      1. Anal sphincter contraction in response to one of following triggers
         1. Slight traction of Foley Catheter or
         2. Compressing/Squeezing glans penis or clitoris
   2. Neurologic function absent below the level of the spinal lesion
      1. Flaccid Paralysis below the spinal lesion
      2. Deep Tendon Reflexes absent below the spinal lesion
4. Precautions: Pitfalls
   1. Intercostal muscle paralysis (hypoventilation)
   2. Anesthesia below lesion
      1. Hidden injuries (e.g. Acute Abdomen without pain)
   3. Transiently shocked spinal cord
      1. Immobilize immediately
5. Management
   1. Immobilize spine with Cervical Collar and Backboard with head blocks and all straps
   2. Frequent ABC evaluation
   3. Careful secondary Trauma survey
   4. Emergent spine surgery Consultation
6. References
   1. (2012) ATLS, ACOS, p. 179-80