Abstract
Purpose of Review
To review the acute and chronic systemic complications of spinal cord injury and discuss treatment recommendations.
Recent Findings
The psychological, social, economic, and permanent neurologic effects associated with spinal cord injury (SCI) have universally persisted over time. Treating acute complications and preventing secondary injury can influence outcome, highlighting the importance of proper management of this patient population.
Summary
Spinal cord injury (SCI) is due to traumatic or non-traumatic causes. Outcome depends on the level of injury and degree of sensorimotor deficits. After the primary injury occurs, it is crucial to detect and treat secondary mechanisms of injury. Correct method of intubation, preventing avoidable complications, and treating cardiovascular, pulmonary, renal, and infectious systemic complications are crucial as they all impact morbidity and mortality in SCI patients.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Bonner S, Smith C. Initial management of acute spinal cord injury. Contin Educ Anesth Crit Care Pain. 2013. doi:10.1093/bjaceaccp/mk021. A comprehensive article on acute spinal cord injury management covering anatomy, pathophysiology, intubation, shock, and management and prevention of systemic complications.
Popa C, Popa F, Grigorean VT, et al. Vascular dysfunctions following spinal cord injury. J Med Life. 2010;3.3:275–85. Discusses the acute cardiovascular complications related to SCI including neurogenic and spinal shock, arrhythmias, and autonomic dysreflexia to name a few with in-depth discussions of acute and chronic management.
Furlan JC, Fehlings MG. Cardiovascular complications after acute spinal cord injury: pathophysiology, diagnosis, and management. Neurosurg Focus. 2008;25(5):E13. This article provides a comprehensive overview of acute cardiovascular complications related to SCI including accurate diagnosis and effective management techniques.
Lo V, Esquenazi Y, Han MK, et al. Critical care management of patients with acute spinal cord injury. J Neurosurg Sci. 2013;57:281–92. Comprehensive review of the critical care management of SCI patients including vascular dysfunction, pulmonary complications, airway technique, and gastrointestinal and genitourinary management.
Dumont RJ, Okonkwo DO, Verma S, et al. Acute spinal cord injury, part 1: pathophysiologic mechanisms. Clin Neuropharmacol. 2001;24.5:254–64. Overview of the various pathophysiology encompassing all types of SCI.
Baptiste DC, Fehlings MG. Pharmacological approaches to repair the injured spinal cord. J Neurotrauma. 2006;23.3/4:318–34.
Stratman RC, Wiesner AM, Smith KM, et al. Hemodynamic management after spinal cord injury. Orthopedics. 2008;31(3):1–6.
McKinely WO, Gittler MS, Kirshblum SC, et al. Spinal cord injury medicine. 2. Medical complications after spinal cord injury: identification and management. Arch Phys Med Rehabil. 2002;83.1:S58–64. Addresses diagnosis and management of systemic complications of spinal cord injury in the acute and chronic settings.
Aarabi B, Harrop JS, Tator CH, et al. Predictors of pulmonary complications in blunt traumatic spinal cord injury. J Neurosurg Spine. 2012;17:38–45. Discusses the expected pulmonary complications of SCI and how to prevent and manage it as this systemic complication greatly contributes to morbidity and mortality.
Wuermser L-A, Ho CH, Chiodo AE, et al. Spinal cord injury medicine. 2. Acute care management of traumatic and nontraumatic injury. Arch Phys Med Rehabil. 2007;88.1:S55–61. Review of management of traumatic and nontraumatic SCI.
Magimairaj H, Hariharan R, Thumbikat P. Orthodeoxia syndrome: a rare complication of ASD in spinal cord injury. Spinal Cord Ser Cases. 2015;1:15005. doi:10.1038/scsandc.20115.5.
Furlan JC, Fehlings MG. Hyponatremia in the acute state after traumatic cervical spinal cord injury. Spine. 2009;34.5:501–11. Hyponatremia is a common complication in SCI patients; this is an excellent article covering etiology, diagnosis, and management.
Sezer N, Akkus S, Gülçin Uğurlu F. Chronic complications of spinal cord injury. World J Orthop. 2015;6(1):24–33. Reviews all chronic complications associated with SCI and correct management.
Nowicki R. Anesthesia for major spinal surgery. Contin Educ Anesth Crit Care Pain. 2013. doi:10.1093/bjaceaccp.mkt041.
Chin KR, Seale J, Cumming V. White cord syndrome of acute tetraplegia after anterior cervical decompression and fusion for chronic spinal cord compression: a case report. Case Rep Orthop. 2013;article ID:697918.
DePasse JM, Palumbo MA, Haque M, et al. Complications associated with prone positioning in elective spinal surgery. World J Orthop. 2015;6.3:351–9. Although rare, post operative visual loss can be devastating after spinal surgery; this article discusses the various causes of prone-positioned visual loss, preventative measures, and treatment.
Martirosyan NL, Feuerstein J, Theodore N, et al. Blood supply and vascular reactivity of the spinal cord under normal and pathological conditions. J Neurosurg Spine. 2011;15:238–51.
Ishizawa K, Komori T, Shimada T, et al. Hemodynamic infarction of the spinal cord: involvement of the gray matter plus the border-zone between the central and peripheral arteries. Spinal Cord. 2005;43:306–10.
Crosby ET. Airway management in adults after cervical spine trauma. Anesthesiology. 2006;104.6:1293–318. Comprehensive article of safe and effective intubation practices in the SCI population.
Sharma S, Singh M, Wani I, et al. Adult spinal cord injury without radiographic abnormalities (SCIWORA): clinical and radiological correlations. J Clin Med Res. 2009;1(1):165–72.
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A special thank you to Dr. John Brust for taking the time to review this manuscript.
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Rochelle Sweis and José Biller declare that they have no conflict of interest.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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This article is part of the Topical Collection on Neurology of Systemic Diseases
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Sweis, R., Biller, J. Systemic Complications of Spinal Cord Injury. Curr Neurol Neurosci Rep 17, 8 (2017). https://doi.org/10.1007/s11910-017-0715-4
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DOI: https://doi.org/10.1007/s11910-017-0715-4