Ziu Endrit, Weisbrod Luke J., Mesfin Fassil B.
UNMC
University of Texas, Long School of Medicine
Spinal shock is the sudden, temporary loss or impairment of spinal cord function below the level of injury that occurs after an acute spinal cord injury (SCI), including the motor, sensory, reflex, and autonomic neural systems. The term "spinal shock" was first used by Hall in 1840. Sherrington further defined this as a transient disappearance of reflexes below the level of SCI. The most common cause of severe SCI leading to spinal shock is a primary insult by high-impact, direct trauma or fall. However, secondary injury (eg, ischemia or infection) of the spinal cord can also result in injury. Other causes of SCI include myelopathies induced by autoimmune, infectious, neoplastic, vascular, and hereditary-degenerative diseases. Although the condition may occur as a result of SCI, spinal shock is a physiologic process rather than an anatomic disorder. Spinal shock may last days to weeks, though there is debate on how the resolution of the condition is defined. The diagnosis of spinal shock is comprised of obtaining relevant history (eg, past medical history, mechanism of injury), if possible, performing a complete physical examination, including evaluation with the Glasgow Coma Scale (GCS) and American Spinal Injury Association (ASIA) Scale, and initiating spinal imaging studies. As with any trauma patient, evaluation for SCIs should be performed after primary assessment with the ABCDE (ie, Airway, Breathing, Circulation, Disability, Exposure) protocol while ensuring spine immobilization during evaluation and transportation to minimize secondary injury. Initial characteristic findings of spinal shock include paralysis and absent reflexes, impaired bowel and bladder control, and absent anal sphincter tone. If the spinal shock is not associated with significant injury of the spinal column itself, then the prognosis for these patients is more favorable than when a fracture is present. The overall treatment of patients with significant spinal shock and injury is a challenge, but aggressive medical management can reduce its effect on the overall functionality of the patient. Management of spinal shock primarily consists of maintaining hemodynamic and respiratory stability to prevent further neurogenic injury and supportive therapy. In some patients, surgical decompression may be considered. However, despite optimal care, deficits following spinal shock may be permanent. Typically, patients with spinal shock have restoration of spinal cord function after a period of recovery; persistent neurological impairment may indicate anatomic SCI. Clinicians should be knowledgeable in the appropriate management of spinal shock, equipping themselves with updated knowledge, skills, and strategies for timely identification and effective interventions to achieve improved interprofessional coordination of care, better patient outcomes, and reduced morbidity.
脊髓休克是指急性脊髓损伤（SCI）后，损伤平面以下脊髓功能突然出现的短暂丧失或损害，包括运动、感觉、反射和自主神经系统。“脊髓休克”一词于1840年由霍尔首次使用。谢灵顿进一步将其定义为SCI平面以下反射的短暂消失。导致脊髓休克的严重SCI最常见的原因是高冲击力、直接创伤或跌倒引起的原发性损伤。然而，脊髓的继发性损伤（如缺血或感染）也可导致损伤。SCI的其他原因包括自身免疫性、感染性、肿瘤性、血管性和遗传性退行性疾病引起的脊髓病。虽然这种情况可能由SCI引起，但脊髓休克是一个生理过程而非解剖学紊乱。脊髓休克可能持续数天至数周，不过对于如何定义病情的缓解存在争议。脊髓休克的诊断包括获取相关病史（如既往病史、损伤机制），如果可能，进行全面的体格检查，包括使用格拉斯哥昏迷量表（GCS）和美国脊髓损伤协会（ASIA）量表进行评估，并启动脊髓影像学检查。与任何创伤患者一样，应在按照ABCDE（即气道、呼吸、循环、残疾、暴露）方案进行初步评估后对SCI进行评估，同时在评估和转运过程中确保脊柱固定，以尽量减少继发性损伤。脊髓休克的初始特征性表现包括瘫痪、反射消失、肠道和膀胱控制受损以及肛门括约肌张力消失。如果脊髓休克与脊柱本身的严重损伤无关，那么这些患者的预后比存在骨折时更有利。对伴有严重脊髓休克和损伤的患者进行全面治疗具有挑战性，但积极的医疗管理可以减轻其对患者整体功能的影响。脊髓休克的管理主要包括维持血流动力学和呼吸稳定以防止进一步的神经源性损伤以及支持性治疗。在一些患者中，可考虑手术减压。然而，尽管进行了最佳治疗，脊髓休克后的功能缺陷可能是永久性的。通常，脊髓休克患者在一段时间的恢复后脊髓功能会恢复；持续的神经功能障碍可能表明存在解剖学上的SCI。临床医生应熟悉脊髓休克的适当管理方法，掌握最新的知识、技能和策略，以便及时识别并进行有效干预，从而实现更好的跨专业护理协调、改善患者预后并降低发病率。
