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Spinal Shock

  • Hyun-Yoon Ko
Chapter

Abstract

When the spinal cord is suddenly severed, all the fundamental functions of the spinal cord below the level of injury including the spinal cord reflexes are immediately depressed, which is referred to as spinal shock. The resolution of spinal shock occurs over a period of days to months, and spinal shock slowly transitions to spasticity. The definition of spinal shock and the pattern of reflex recovery or evolution remains as an issue of debate and controversy. The identification of clinical signs that determine the duration of spinal shock is controversial. The underlying mechanisms of spinal shock are also not clearly defined.

References

  1. Atkinson PP, Atkinson JLD. Spinal shock. Mayo Clin Proc. 1996;71:384–9.CrossRefGoogle Scholar
  2. Bach-y-Rita P, Illis LS. Spinal shock: possible role of receptor plasticity and non synaptic transmission. Paraplegia. 1993;31:82–7.PubMedGoogle Scholar
  3. Barnes CD, Schadt JC. Release of function in the spinal cord. Prog Neurobiol. 1979;12:1–13.CrossRefGoogle Scholar
  4. Bastian HC. On the symptomatology of total transverse lesions of the spinal cord; with special reference to the condition of the various reflexes. Med Chir Trans. 1890;73:151–217.CrossRefGoogle Scholar
  5. Bunge RP, Puckett WR, Becerra JL, et al. Observations on the pathology of human spinal cord injury. A review and classification of 22 new cases with details from a case of chronic cord compression with extensive focal demyelination. In: Seil FJ, editor. Advances in neurology. New York: Raven Press Ltd; 1993. p. 75–89.Google Scholar
  6. Calancie B, Broton JG, Klose KJ, et al. Evidence that alterations in presynaptic inhibition contribute to segmental hypo-and hyperexcitability after spinal cord injury in man. Electroencephalogr Clin Neurophysiol. 1993;89:177–86.CrossRefGoogle Scholar
  7. Calancie B, Molano MR, Broton JG. Tendon reflexes for predicting movement recovery after acute spinal cord injury in humans. Clin Beurophysiol. 2004;115:2350–63.CrossRefGoogle Scholar
  8. Christensen PB, Wermuth L, Hinge HH, et al. Clinical course and long-term prognosis of acute transverse myelopathy. Acta Neurol Scand. 1990;81:431–5.CrossRefGoogle Scholar
  9. Dimitrijević MR, Nathan PW. Studies of spasticity in man: 3. Analysis of reflex activity evoked by noxious cutaneous stimulation. Brain. 1968;91:349–68.CrossRefGoogle Scholar
  10. Ditunno JF, Little JW, Tessler A, et al. Spinal shock revisited: a four-phase model. Spinal Cord. 2004;42:383–95.CrossRefGoogle Scholar
  11. Fam B, Yalla SV. Vesicourethral dysfunction in spinal cord injury and its management. Semin Neurol. 1988;8(2):150–5.CrossRefGoogle Scholar
  12. Guillain G, Barre JA. Etude anatomo-clinique de quinze cas de section totalle de la moelle. Annales de Médecine. 1917;2:178–222.Google Scholar
  13. Guttmann L. Studies on reflex activity of the isolated cord in spinal man. J Nerv Ment Dis. 1952;116:957–72.CrossRefGoogle Scholar
  14. Guttmann L. Spinal shock and reflex behaviour in man. Paraplegia. 1970;8:100–16.PubMedGoogle Scholar
  15. Guttmann L. Spinal cord injuries: comprehensive management and research. 2nd ed. Oxford (England): Blackwell Scientific Publications; 1976.Google Scholar
  16. Hall M. Second memoir on some principles of the pathology of the nervous system. Med Chir Trans. 1840;23:121–67.CrossRefGoogle Scholar
  17. Hall M. On the diseases and derangements of the nervous system: in their primary forms and in their modifications by age, sex, constitution, hereditary predisposition, excesses, general disorder, and organic disease. London: H. Baillière; 1841.Google Scholar
  18. Hiersemenzel LP, Curt A, Dietz V. From spinal shock to spasticity: neuronal adaptations to a spinal cord injury. Neurology. 2000;54:1574–82.CrossRefGoogle Scholar
  19. Holdsworth FW. Neurological diagnosis and the indications for treatment of paraplegia and tetraplegia, associated with fractures of the spine. Manit Med Rev. 1968;48:16–8.PubMedGoogle Scholar
  20. Illis LS. The motor neuron surface and spinal shock. Mod Trends Neurol. 1967;4:53–68.PubMedGoogle Scholar
  21. Ko HY, Ditunno JF, Graziani V, et al. The pattern of reflex recovery during spinal shock. Spinal Cord. 1999;37:402–9.CrossRefGoogle Scholar
  22. Landau WM, Clare MH. The plantar reflex in man, with special reference to some conditions where the extensor response is unexpectedly absent. Brain. 1959;82:321–55.CrossRefGoogle Scholar
  23. Leis AA, Kronenberg MF, Stĕtkárová I, et al. Spinal motoneuron excitability after acute spinal cord injury in humans. Neurology. 1996;47:231–7.CrossRefGoogle Scholar
  24. Levi L, Wolf A, Belzberg H. Hemodynamic parameters in patients with acute cervical cord trauma: description, intervention, and prediction of outcome. Neurosurgery. 1993;33:1007–16.PubMedGoogle Scholar
  25. Lloyd LK. New trends in urologic management of spinal cord injured patients. Cent Nerv Syst Trauma. 1986;3:3–12.CrossRefGoogle Scholar
  26. McCouch GP, Austin GM, Liu CN, et al. Sprouting as a cause of spasticity. J Neurophysiol. 1958;21:205–16.CrossRefGoogle Scholar
  27. Mendell LM. Physiological aspects of synaptic plasticity: the Ia/motoneuron connection as a model. Adv Neurol. 1988;47:337–60.PubMedGoogle Scholar
  28. Nacimiento W, Noth J. What, if anything, is spinal shock? Arch Neurol. 1999;56:1033–5.CrossRefGoogle Scholar
  29. Petersen JA, Schubert M, Dietz V. The occurrence of the Babinski sign in complete spinal cord injury. J Neurol. 2010;257:38–43.CrossRefGoogle Scholar
  30. Riddoch G. The reflex functions of the completely divided spinal cord in man, compared with those associated with less severe lesions. Brain. 1917;40:264–402.CrossRefGoogle Scholar
  31. Ruch TC. Evidence of the non-segmental character of spinal reflexes from an analysis of the cephalad effects of spinal transection (Schiff-Sherrington phenomenon). Am J Physiol-Legacy Content. 1935;114:457–67.CrossRefGoogle Scholar
  32. Schadt JC, Barnes CD. Motoneuron membrane changes associated with spinal shock and the Schiff-Sherrington phenomenon. Brain Res. 1980;201:373–283.CrossRefGoogle Scholar
  33. Sherrington C. The integrative action of the nervous system. London: Constable & Company LTD; 1906.Google Scholar
  34. Silver JR. Early autonomic dysreflexia. Spinal Cord. 2000;38:229–33.CrossRefGoogle Scholar
  35. Simpson RK Jr, Robertson CS, Goodman JC. Glycine: an important potential component of spinal shock. Neurochem Res. 1993;18:887–92.CrossRefGoogle Scholar
  36. Simpson RK Jr, Robertson CS, Goodman JC. The role of glycine in spinal shock. J Spinal Cord Med. 1996;19:215–24.CrossRefGoogle Scholar
  37. Stauffer ES. Diagnosis and prognosis of acute cervical spinal cord injury. Clin Orthop Relat Res. 1975;112:9–15.Google Scholar
  38. Sullivan MP, Yalla SV. Detrusor contractility and compliance characteristics in adult male patients with obstructive and nonobstructive voiding dysfunction. J Urol. 1996;155:1995–2000.CrossRefGoogle Scholar
  39. Tai Q, Goshgarian HG. Ultrastructural quantitative analysis of glutamatergic and GABAergic synaptic terminals in the phrenic nucleus after spinal cord injury. J Comp Neurol. 1996;372:343–55.CrossRefGoogle Scholar
  40. Van Gijn J. The Babinski sign and the pyramidal syndrome. J Neurol Neurosurg Psychiatry. 1978;41:865–73.CrossRefGoogle Scholar
  41. Van Gijn J. The Babinski sign: the first hundred years. J Neurol. 1996;243:675–83.CrossRefGoogle Scholar
  42. van Harreveld A. On spinal shock. Proc Natl Acad Sci U S A. 1940;26:65–7.CrossRefGoogle Scholar
  43. van Munster CE, Weinstein HC, Uitdehaag BM, et al. The plantar reflex: additional value of stroking the lateral border of the foot to provoke an upgoing toe sign and the influence of experience. J Neurol. 2012;259:2424–8.CrossRefGoogle Scholar
  44. Weaver RA, Landay WM, Higgins JF. Fusimotor function: Part II. Evidence of fusimotor depression in human spinal shock. Arch Neurol. 1963;9:127–32.CrossRefGoogle Scholar
  45. Weinstein DE, Ko HY, Graziani V, et al. Prognostic significance of the delayed plantar reflex following spinal cord injury. J Spinal Cord Med. 1997;20:207–11.CrossRefGoogle Scholar
  46. White RJ, Likavec MJ. Spinal shock-spinal man. J Trauma. 1999;56:979–80.CrossRefGoogle Scholar
  47. Wolpaw JR, Tennissen AM. Activity-dependent spinal cord plasticity in health and disease. Annu Rev Neurosci. 2001;24:807–43.CrossRefGoogle Scholar

Suggested Reading

  1. American Spinal Injury Association. International standards for neurological classification of Spinal Cord injury. Revised 2011. Updated 2015th ed. Atlanta: American Spinal Injury Association; 2015Google Scholar
  2. Buchanan LE, Nawoczenski DA, editors. Spinal cord injury-concepts and management approaches. Baltimore: Williams & Wilkins; 1987.Google Scholar
  3. Campbell WW. DeJong’s the neurologic examination. 7th ed. New York: Wolters Kluwer Lippincott Williams & Wilkins; 1992.Google Scholar
  4. Eagler GL, Cole J, Merton WL (eds) (1998) Spinal cord diseases: diagnosis and treatment, Marcel Dekker Inc., New York.Google Scholar
  5. Fehlings MG, Vccaro AR, Roakye M, Rossignol S, Ditunno JF, Burns AS, editors. Essentials of spinal cord injury: basic research to clinical practice. New York: Thieme; 2013.Google Scholar
  6. Fulton JF, Keller AD. The sign of Babinski: a study of the evolution of cortical dominance in primates. Springfield: Charles C Thomas; 1932.Google Scholar
  7. Harrison P. Managing spinal injury: critical care. The international management of people with actual or suspected spinal cord injury in high dependency and intensive care unit. London: The Spinal Injury Association; 2000.Google Scholar
  8. Illis LS, editor. Spinal cord dysfunction: assessment. Oxford: Oxford University Press; 1988.Google Scholar
  9. Jallo J, Vaccaro AR, editors. Neurotrauma and critical care of the spine. 2nd ed. New York: Thieme; 2018.Google Scholar
  10. Kennedy P, editor. The Oxford handbook of rehabilitation psychology. Oxford: Oxford University Press; 2012.Google Scholar
  11. Neuburger M. The historical development of experimental brain and spinal cord physiology before Flourens. Baltimore: The Johns Hopkins University Press; 1981.Google Scholar
  12. Vaccaro AR, Fehlings MG, Dvorak MF, editors. Spine and spinal cord trauma, evidence-based management. New York: Thieme Medical Publishers; 2011.Google Scholar
  13. Vanderah T, Gould DJ. Nolte’s the human brain. Philadelphia: Elsevier; 2016.Google Scholar
  14. Verhaagen J, McDonald JW III. Spinal cord injury. In: Aminoff MJ, Boller F, Swaab DF, editors. Handbook of clinical neurology, 3rd series, vol. 109. London: Elsevier; 2012.Google Scholar
  15. Vinken PJ, Bruyn GW, editors. Injuries of the spine and spinal cord. Part I, Handbook of clinical neurology, vol, vol. 25. Oxford: North-Holland Publishing Company; 1976.Google Scholar
  16. Weaver LC, Polosa C, editors. Autonomic dysfunction after spinal cord injury. In: progress in brain research, vol. 152. New York: Elsevier; 2006.Google Scholar
  17. Weidner N, Rupp R, Taney KE, editors. Neurological aspects of spinal cord injury. Cham: Springer; 2017.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Hyun-Yoon Ko
    • 1
  1. 1.Department of Rehabilitation MedicineRehabilitation Hospital, Pusan National University Yangsan Hospital, Pusan National University School of MedicineYangsanSouth Korea

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