Spinal Shock: Causes, Symptoms, Diagnosis & Treatment

Spinal shock is a temporary loss or reduction of spinal cord function below the level of an acute spinal cord injury. It affects movement, sensation, reflexes and automatic body functions such as bladder control.

When does it happen? It develops right after a sudden injury to the spinal cord, such as from a car crash or a fall. StatPearls describes it as a physiologic state that can last days to weeks, rather than a separate structural injury.

Spinal shock is not caused by routine spinal anesthesia. The numbness from a spinal anesthetic is planned and wears off as the medicine does.

How Will You Diagnosed Your Patient Have Spinal Shock?

Spinal shock is diagnosed in the hospital after a spinal cord injury. Doctors examine strength, sensation and reflexes below the injury, and they use imaging such as CT and MRI to look at the spine and spinal cord.

Because reflexes are temporarily absent, it can be hard to tell at first how severe the lasting injury will be. Doctors reassess as reflexes return, which happens gradually over days to weeks.

Signs & Symptoms of Spinal Shock

Signs and symptoms depend on where the spinal cord is injured and how severe the injury is.

Signs of spinal shock after a spinal cord injury include loss of muscle tone and paralysis (flaccid paralysis) below the level of the injury, and loss of sensation and absent reflexes below the injury.

• Low blood pressure, with cervical or upper back injuries
• Low body temperature (hypothermia)
• Loss of bowel and bladder control, or urine retention
• Absent tone in the anal sphincter
• Prolonged erection (priapism) in men
• Slow heart rate, with cervical or upper back injuries
• Breathing difficulty, with high neck injuries

Any suspected spinal cord injury is a medical emergency. Call 911 and do not move the person unless they are in danger.

Later, once spinal shock resolves, people with injuries at the upper back or neck can develop autonomic dysreflexia, a sudden spike in blood pressure that can cause a pounding Headache and needs urgent treatment.

Difference Between Spinal Shock And Neurogenic Shock?

The "shock" in spinal shock refers to the loss of spinal cord function, not to circulatory collapse. Don't confuse it with neurogenic shock, which is a life-threatening drop in blood pressure.

Neurogenic shock: this is the circulation problem. Injury to the spinal cord, usually in the neck or upper back, disrupts the nerves that keep blood vessels tight and the heart rate up. Cleveland Clinic explains that this causes low blood pressure and can slow the heart rate.

Spinal shock, by contrast, is the loss of movement, sensation and reflexes below the injury. The two often happen together after a serious spinal cord injury.

The hospital team monitors blood pressure, heart rate, breathing and neurological function closely to tell them apart and treat both.

Common Causes of Spinal Shock

Spinal shock is caused by acute injury to the spinal cord. The most common causes of spinal cord injuries are

• History of Fall

  After the age of 65, the most common cause of spinal cord injury is a fall.

• Automobile Accidents

  Motor vehicle crashes and other high-impact trauma are a leading cause of spinal cord injury.

• Violence, such as gunshot or stab wounds

• Sports injuries

• Disc prolapse pressing on the cord

• Some diseases, such as cancer that spreads to the spine, or a spinal abscess

Management of Spinal Shock

There is no specific treatment that reverses spinal shock itself, and researchers are still looking for ways to repair damaged spinal cord nerves. Treatment focuses on protecting the spinal cord from further damage and preventing complications.

1. Airway and breathing

   Breathing comes first. People with neck or upper back injuries may need oxygen or a breathing machine. Low oxygen can cause further damage to the brain and spinal cord.

2. Circulation

   The team monitors blood pressure and heart rate closely. If blood pressure is low, they may give IV fluids and medicines that raise blood pressure, such as norepinephrine, a close chemical relative of dopamine that is often preferred because it helps both blood pressure and heart rate. A very slow heart rate may be treated with atropine. These treatments are given only in a hospital.

3. Immobilization

   The neck and spine are kept still to prevent more damage, usually with a cervical collar and a rigid board. Sometimes traction or surgery is needed to realign and stabilize the spine.

4. Preventing complications

   Care includes preventing blood clots, pressure sores and pneumonia, plus bladder and bowel management, nutrition, pain control and physical therapy. Antibiotics are used only to treat or prevent specific infections.

5. Surgery

   Surgery may be done to take pressure off the spinal cord, remove bone fragments or foreign objects, and stabilize the spine.

Spinal shock itself is temporary, and reflexes gradually return. How much movement and sensation comes back depends on how badly the spinal cord was damaged. Quick, expert care and rehabilitation can help prevent complications and support recovery of bladder and bowel control, muscle function, sexual health and mental health.

Sources

• Spinal Shock, StatPearls (NCBI Bookshelf)
• Neurogenic Shock, StatPearls (NCBI Bookshelf)
• Neurogenic Shock: What It Is, Symptoms & Treatment, Cleveland Clinic