Summary

• An understanding of the issues related to chronic spinal cord injury should commence from an appreciation of the events that caused the primary injury.
• Primary injury results from acute mechanical trauma, compression by a space-occupying lesion, or a vascular insult. The injury may be exacerbated by ischaemia or inflammation.
• The aim of diagnosis is to carefully assess the extent of neurological injury, the degree of residual sensory and motor function, and to identify complications.
• Common associated problems include bladder or bowel dysfunction, constipation, neurogenic pain, gait disturbance, contractures, sexual dysfunction, and autonomic dysreflexia.
• Management involves intensive rehabilitation to optimise mobility and hand function, prevention of complications, bladder and bowel management, and analgesia. Surgical decompression may be required for progressive neurological deficits.
• Full recovery of neurological function is unlikely, and the outcome depends on the residual function and the success of rehabilitation. Patients have a decreased life expectancy compared with the general population.
• Complications include dysphagia, DVT, contractures, pressure sores, orthostatic hypotension, heterotopic ossification, dependent oedema, and osteoporosis.