Medical complications of SCI

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Original Editor - George Prudden

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Introduction

Spinal cord injury results not only in motor and sensory deficits but also in autonomic dysfunctions as a result of the disruption between higher brain centers and the spinal cord. Autonomic dysfunction can include compromised cardiovascular, respiratory, urinary, gastrointestinal, thermoregulatory, and sexual activities. Maintaining optimal health and well-being after sustaining a spinal cord injury can be a challenge.  Common secondary health conditions like pressure sores, spasms, chronic pain, and urinary tract infections often negatively affect quality of life and social participation.

Autonomic Dysfunction

Neurogenic Shock

Autonomic Dysreflexia

Autonomic dysreflexia is a potentially but often unrecognised life-threatening condition and should be considered a medical emergency that requires immediate intervention. It is an acute syndrome characterised by a sudden excessive increase in Systolic Blood Pressure caused by any "Noxious Stimuli" below the level of lesion, which can occur in individuals with spinal cord lesions above the T6 secondary to the loss of connection between the brain and spinal cord.

When a noxious stimuli occurs in a region of the body below the injury level, there is an increase in sympathetic nervous system activity. The brain is unable to check the sympathetic response resulting in an increased systemic blood pressure.

This overstimulation of the autonomic nervous system ischaracterised by sudden onset of severe high blood pressure known as paroxysmal hypertension, which manifests itself with flushing, pounding headache, irritability, pilo erection, goose bumps, profuse sweating above the level of the injury, dry and pale skin caused by vasoconstriction below the level of the injury, blurred vision, nasal congestion, bradycardia, cardiac arrhythmias, atrial fibrillation often associated with anxiety .(Krassioukov et al, 2009) [1]

Noxious Stimuli can include bladder infection, urinary stasis, bowel obstruction, pressure on bony areas or pressure sores, improper positioning, tight clothings, catheter clamping / blockage, twisted Intercostal drainage tubes, after sudden violent hip range of motion, esp. SLR, extreme hot weather.

Measuring Blood pressure & treating for the same. When non-pharmacologic treatment methods are not successful in the acute episode of AD, pharmacologic agents are required and may include nifedipine, nitrates, and captopril.  Only nifedipine has been supported by controlled trials (Krassioukov et al, 2009).


Temperature Regulation

Respiratory Dysfunction

Impaired respiratory function is common following SCI. Typical respiratory complications following SCI include hypoventilation, atelectasis, secretion retention and pneumonia. Respiratory function of people with SCI is primarily determined by neurological level. Paralysis or partial paralysis of key muscles has a marked impact on respiratory function.

Cardiovascular Dysfunction

Deep Vein Thrombosis and Pulmonary Embolism

Orthostatic Hypotension

Gastrointestinal Dysfunction

Paralytic Ileus

Neurogenic Bowel

Upper Motor Neuron Bowel Syndrome

Lower Motor Neuron Bowel Syndrome

Urological Dysfunction

Neurogenic Bladder

Hypereflexia of Detrusor and Sphincter 

Areflexia of Detrusor and Sphincter

Areflexia of Detrusor with Hyperreflexia of Sphincter

Hyperreflexia of Detrusor with Areflexia of Sphincter

Sexual Dysfunction

Fertility

Erectile Dysfunction

Bone Metabolism Dysfunction

Osteoporosis

Heterotrophic Ossification

Heterotopic ossification is when a bone is formed in or around a joint resulting to the absence of movements of that joint this is commonly seen in spinal cord injury patients. It usually presents within joints like shoulder, elbow, knee etc.its first sign is swelling around the joint and reduced range of motion, pain and with or without fever.

Pressure Sores

Pain

Nociceptive

Neuropathic

Psychological

Depression

Anxiety

Post Traumatic Stress Disorder

References

  1. Khastgir J, Drake MJ, Abrams P. Recognition and effective management of autonomic dysreflexia in spinal cord injuries. Expert Opinion on Pharmacotherapy. 2007 May;8(7):945–56.
  2. Physiopedia. Craig Hospital. What is Autonomic Dysreflexia?. Available from: https://youtu.be/2qGBVp3Ipvo[last accessed 30/10/18]
  3. Physiopedia. A introduction to the new Physiopedia Plus. Available from: https://youtu.be/qrwScjDR5NI[last accessed 30/10/18]