Chronic Complications of Spinal Cord Injury (SCI)

Life Expectancy:
1. Mortality rates highest during 1st year
2. >1 yr, then ~90% of normal

Cardiovascular Complications:
1. Autonomic dysreflexia: SCI>T6 due to uninhibited sympathetic responses
      A. Occurs in 20~70%, >1 m to <1 yr
      B. Not Below T6 b/c intact splanchnic innervation allows for compensatory dilatation of the splanchnic vascular bed.
      C. Prevent stimuli, ex. bladder distention, bowel impaction, pressure sores, bone fracture, or occult visceral disturbances
      D: S/S: HA, diaphoresis, HTN, flushing, piloerection, blurred vision, nasal obstruction, and nausea.
             a. profound bradycardia, OHCA, ICH, seizures
      E. Tx:
           a. Measure BP
           b. Sitting the patient upright to orthostatically lower BP
           c. Search for noxious stimuli
           d. BP meds: nitrates, nifedepine, sublingual captopril, IV hydralazine, IV labetalol
2. CAD
      A. Risk factors:  decreased muscle mass, increased fat, and inactivity, 3~10X more likely. Esp. >T5 level
      B. Tx same as non-SCI pts
3. Orthostatic hypotension
     A: More common in 1st several months of SCI, but can still occur due to excessive bed rest+ low fluid intake
4. Bradycardia (>T6)
     A: baseline pressure reduced

Acute Traumatic Spinal Cord Injury (TSCI)

Incidence:
40 million persons per year

Causes of TSCI:
●Motor vehicle accidents: 47 percent
●Falls: 23 percent
●Violence (especially gunshot wounds): 14 percent
●Sports accidents: 9 percent
●Other: 7 percent

S/S:  Based on severity, assess by American Spinal Injury Association Scale (ASIA):
1. Complete cord injury (ASIA grade A): reduced S+M at the level below, then no sensory + motor at all
        Acute: reflex (-), flaccid muscle tone, plantar stimulation (-), bulbocavernosus reflex (-), anal sensation (-), urinary retention, bladder distension, (priapism)

2. Incomplete cord injury (ASIA grades B through D): S+M partially preserved below the level of injury.               
        1. S preserved>M b/c more peripheral
        2. bulbocavernosus reflex, anal sensation (+)      

3. Central cord syndrome: preexisting cervical spondylosis + mild trauma
        1. M impairment > S in upper ext. than lower ext.
        2. Bladder dysfunction
        3. Sensory loss below level of lesion      
      *esp. hyperextension injury

4. Anterior Cord Syndrome: usu. anterior spinal a. injury by bone fragments
        1. Weakness and reflex changes
        2. Bilateral loss of pain and temperature sensation
        3. Urinary incontinence
        4.  Tactile, position, and vibratory sensation are normal (Dorsal column spared)

Spinal shock: hrs ~ wks
        Immediately after injury, loss of all spinal cord function caudal to level of injury
             ●Bradycardia, hypotension, flaccid paralysis, anesthesia, bowel and bladder control (-), reflex (-),                  (priapism)
        Mechanism: reduced axonal transmission due to K+ loss in cells of the cord