Chronic spinal cord injury

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, autonomic dysreflexia, and development of a syrinx.

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.

Chronic spinal cord injury refers to a permanent and/or progressive interruption in the conduction of impulses across the neurons and tracts of the spinal cord. It may be due to mechanical distortion or vascular ischaemia of the spinal cord arising from trauma, tumour, infection or other space-occupying lesions. The term is generally used when elements of spinal cord injury have been present for at least 1 year. Commensurate neurological deficits occur that may be stable or progressive and lead to disability with spasticity, joint contractures, sensory changes, and sphincter and locomotion abnormalities.