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 ischemia 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 neurologic complications such as syringomyelia and spinal or foraminal stenosis.
Management involves intensive rehabilitation to optimize mobility and hand function, prevention of complications, bladder and bowel management, and analgesia. Surgical decompression may be required for progressive neurologic deficits.
Full recovery of neurologic 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 edema, 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 nontraumatic cause, such as mechanical distortion or vascular ischaemia of the spinal cord arising from trauma, tumor, 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 neurologic deficits occur that may be stable or progressive and lead to disability with associated spasticity, joint contractures, sensory changes, and sphincter and locomotion abnormalities.
History and exam
Key diagnostic factors
- motor weakness
- loss of fine motor coordination
- paresthesia, numbness, dysesthesia
- hyperreflexia and ankle clonus
- pathologic reflexes
- loss of perianal sensation, voluntary anal contraction and anal tone
- autonomic dysreflexia
Other diagnostic factors
- central (midline) pain
- girdle pain
- musculoskeletal or visceral pain
- unsteady gait
- urinary incontinence or retention
- sexual dysfunction
- nonspecific malaise
- radicular pain
- spinal cord trauma or ischemia
- higher-level spinal cord lesion
- extremes of age
- narrow spinal canal
- male sex
Investigations to consider
- MRI spine
- urodynamic studies
- bladder ultrasound
- renal ultrasound
- micturition cystourethrogram
- bone densitometry (DEXA)
- laboratory evaluation
progressive neurologic deficit
stable neurologic status
- Noncompressive myelopathy
- Compressive myelopathy
- Best practice guidelines: spine injury
- CDC clinical practice guideline for prescribing opioids for pain: United States, 2022
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