Understanding spinal shock

[Alex Turcios]

Hi,
Spinal shock is defined as the absense of all neurologic activity below the level of injury. But what if one is a complete SCI below the injury with no zone of partial preservation? Does this mean they are in spinal shock forever? Does the term “spinal shock” ever get dropped for this type of patient?

[Chrissy Durrough Lugge]

Hi Alex,
Spinal shock always resolves over a period of days to months – even if someone has a complete spinal cord injury. There are a number of indicators that spinal shock has resolved. In the case of a complete SCI without lower motor neuron injury, the easiest signs to recognize are the emergence of spasticity and/or return of deep tendon reflexes.

If you want to get into the weeds of spinal shock, this article has some good info and I included an excerpt below: Ko H. Revisit spinal shock: pattern of reflex evolution during spinal shock. Korean J Neurotrauma. 2018;14(2):47-54.

“Spinal shock usually lasts for days or weeks after spinal cord injury and the average duration is 4 to 12 weeks. Spinal shock is terminated earlier and the pyramidal tract signs and defense reactions occur sooner in incomplete lesions than with complete transverse lesions. The identification of clinical signs that determine the duration of spinal shock is controversial. There is no uniform consensus on defining the cessation of spinal shock. Most references define the end of spinal shock with a return of specific reflexes. However, not all reflexes are uniformly depressed in each patient. Reflexic changes are individualized. The resolution of spinal shock occurs over a period of days to months, and spinal shock slowly transitions to spasticity. Various authors have defined the termination of spinal shock as the appearance of the bulbocavernosus reflex, the recovery of deep tendon reflexes, or the return of reflexic detrusor activity. Nevertheless, there are many questions to answer, such as: When should we define spinal shock as the end? What types of reflexes appear first among polysynaptic cutaneous reflexes, monosynaptic deep tendon reflexes, and pathological reflexes? Should it include changes in autonomic reflexes such as a detrusor reflex?”

[Alex Turcios]

Interesting, so even if a person is a complete SCI, they will always have some return of reflexes?

[Chrissy Durrough Lugge]

As long as there are not also LMN injuries

[Author]

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