Chronic spinal cord injury

Chronic spinal cord injury is a term generally used when elements of spinal cord injury have been present for at least 1 year.

Primary injury results from acute mechanical trauma, compression by a space-occupying lesion, infection, or a vascular insult. The injury may be exacerbated by ischaemia or inflammation.

The aim of diagnosis is to identify patients who have progressive pathology and to thoroughly assess the disability produced by the injury to guide rehabilitation.

Common problems associated with chronic spinal cord injury include bladder and/or bowel dysfunction, pain (neurogenic and musculoskeletal), gait disturbances, soft-tissue contractures, sexual dysfunction, cardiovascular dysautonomia (including autonomic dysreflexia), and development and/or progression of long-term neurological complications such as syringomyelia and spinal or foraminal stenosis.

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 outcome depends on residual function and the success of rehabilitation. Patients have a decreased life expectancy compared with the general population.

Frequently encountered complications include dysphagia, venous thrombo-embolic conditions, soft-tissue and joint contractures, pressure injuries, orthostatic hypotension, heterotopic ossification, dependent oedema, and low bone mass or osteopenia/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 a traumatic or a non-traumatic cause, such as 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 associated spasticity, joint contractures, sensory changes, and sphincter and locomotion abnormalities.