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REFERAT

SPINAL SHOCK 

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 Transection of the spinal cord

•Complete Transection

• Incomplete Transection

•Hemi section

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Complete transection of spinal cord

•

Common causes of Completetransection are

• unshot in!uries"

•

#islocation of spine"• Occlusion of the $lood %essels&

• Common site of in%ol%ement is atmid thoracic le%el

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Clinical sta'es

• Sta'e of spinal shoc(

• Sta'e of re)e* acti%it+"

• Sta'e of re)e* failure

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Sta'e of spinal shoc(

• E,ects depends on site of in!ur+

• Complete transection in cer%ical re'ion-a$o%e c./ is fatal paral+sis ofrespirator+ muscles

• In 0uic( trasection of spinal cordpatient feel as it has $een cut in to t1o

portions" upper portion is una,ectedand in lo1er part all the motor acti%it+sensations are lost

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Spinal Shoc(In all %erte$rates" transection of the

spinal cord is follo1ed $+ a period ofspinal shock  durin' 1hich all spinalre)e* responses are profoundl+depressed& Su$se0uentl+" re)e*

responses return and $ecomeh+peracti%e& The duration of spinalshoc( is proportionate to the de'ree ofencephali2ation of motor function inthe %arious species& In fro's and rats itlasts for minutes3 in do's and cats itlasts for 4 to 5 h3 in mon(e+s it lasts for

da+s3 and in humans it usuall+ lasts fora minimum of 5 1(&

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Characteristic e,ects of spinal shoc(

• 6otor E,ectsParaple'ia"7uadriple'ia

• Loss of tone 6uscles $ecome

)accid• A re)e*ia All the super8cial and

deep re)e*eses are lost

• Sensor+ E,ects All Sensationsare lost $elo1 the le%el of transection

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Complete lesions a$o%e T4 1ill therefore eliminate alls+mpathetic out)o1&

Lesions $et1een T4 and T9 1ill preser%e s+mpathetictone inthe head and upper e*tremities $ut den+ it to theadrenals and

the lo1er e*tremities&Lesions $et1een T9 and the lum$ar cord 1ill preser%eadrenal inner%ation $ut dener%ate the lo1ere*tremities&

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:asomotor E,ects

• S+mpathetic 8$ers lea%e the spinalcord $et1een T4 and L5

•  Transection at the le%el of T4Sharp fall in $lood pressure-6;P

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 The cause of spinal shoc( is uncertain&Cessation of tonic $om$ardment of spinal

neurons $+ e*citator+ impulses indescendin' path1a+s undou$tedl+ pla+s arole" $ut the su$se0uent return of re)e*esand their e%entual h+peracti%it+ also ha%e to

$e e*plained& The reco%er+ of re)e*e*cita$ilit+ ma+ $e due to the de%elopmentof dener%ation h+persensiti%it+ to themediators released $+ the remainin' spinale*citator+ endin's& Another possi$ilit+ for1hich there is some e%idence is thesproutin' of collaterals from e*istin'

neurons" 1ith the formation of additionale*citator endin s on interneurons and

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 The 8rst re)e* response to appear asspinal shoc( 1ears o, in humans is often a

sli'ht contraction of the le' )e*ors andadductors in response to a no*iousstimulus& In some patients" the (nee !er(re)e* reco%ers 8rst& The inter%al $et1eencord transection and the return of re)e*acti%it+ is a$out 5 1ee(s in the a$sence ofan+ complications" $ut if complications are

present it is much lon'er& It is not (no1n1h+ infection" malnutrition" and othercomplications of SCI inhi$it spinal re)e*

acti%it+& Once the spinal re)e*es $e'in to

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SPINAL SHOCK 

By: Dr Ismah, Ortho department 

5>

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Contents

• #e8nition

• Anatom+

•

Pathoph+siolo'+• Phases

• :s& neuro'enic shoc(

• 6ana'ement

5<

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#e8nition

5.

• Immediate temporar+ loss of totalpo1er" sensation and re)e*es $elo1the le%el of in!ur+

• ? Loss of $ul$o@ca%ernous re)e*

• suall+ reco%er 1ithin 5

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59

$ul$o@ca%ernous re)e*

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Anatom+

5

http://www.radiologyassistant.nl/en/p4!"#$%&'d$d'/s

 pine-thora#ol(mbar-in)(ry.html

Dennis threecolumn@spine sta$ilit+

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5B*alter B. +reene. etters Orthopaedi#s st  ed. '!!"

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Pathoph+siolo'+

5D

 TRA6A @@ SCI  causes a concussion li(e in!ur+ to spinal cord

total sensor+ and motor po1er loss and loss of allre)e*es for initial some periodfollo1ed $+ then 'radual reco%er+ of re)e*es

• Re)e*es in the SC caudal to the SCI are depressed-are)e*ia/

•  This state of sensor+ and motor loss alon' 1ith total lossof re)e*es follo1in' trauma is (no1n as spinal shoc(

•  The shoc( in spinal shoc( does not refer to circulator+collapse

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Phases

Phase Time Physical examfndings

Underlyingphysiological event

1  =@4 da+s Are)e*ia Loss of descendin'facilitation

2 4@> da+s Initial re)e* return #ener%ationsupersensiti%it+

3 4@< 1ee(s H+perre)e*ia A*on@supporteds+napse 'ro1th

4 4@45months

H+perre)e*ia"Spasticit+

Soma@supporteds+napse 'ro1th

http://www.nat(re.#om/s#/)o(rnal/4'/n0/f(ll/%!"!%a.html

>=

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Phase 1G

• A complete loss or 1ea(enin' of all re)e*es$elo1 the le%el of spinal cord in!ur+

• Spinal concussion caused the neuronsin%ol%ed in %arious re)e* arcs and the

neural input from the $rain $ecomeh+perpolari2ed and unresponsi%e&

>4

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Phase 2

• Characteri2ed $+ the return of some re)e*es& The 8rst re)e*es to reappear is the

$ul$oca%ernosus re)e*

• The reason re)e*es return is theh+persensiti%it+ of re)e* muscles follo1in'

dener%ation3 more receptors forneurotransmitters are e*pressed and aretherefore the+ are easier to stimulate&

>5

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Phases 3 and 4

• Characteri2ed $+ h+perre)e*ia

• Neurons $elo1 the in!ur+ attempt to

reesta$lish the s+napses

>>

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Spinal %s neuro'enic shoc(

>

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>.

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The ational Spinal %ord &n'uryStudy ()S%&S*

>9

• NASCIS > SA" 4DD

• Hi'h dose meth+lprednisolone

• Pre%ent secondar+ in!ur+ of SCI

• R* start 1ithin > hrs for 5< hrs

• Side e,ectsG immunosuppression" IT$leedin'" h+per'l+cemia and AR#S

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>

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Thank you

>B