Chronic spinal cord injury

Last reviewed: 25 Aug 2022
Last updated: 20 Sep 2022

Summary

Definition

History and exam

Key diagnostic factors

  • motor weakness
  • loss of fine motor coordination
  • spasticity
  • paresthesia, numbness, dysesthesia
  • hyperreflexia and ankle clonus
  • pathologic reflexes
  • contractures
  • loss of perianal sensation, voluntary anal contraction and anal tone
  • autonomic dysreflexia
  • syrinx
More key diagnostic factors

Other diagnostic factors

  • central (midline) pain
  • girdle pain
  • musculoskeletal or visceral pain
  • unsteady gait
  • urinary incontinence or retention
  • constipation
  • sexual dysfunction
  • nonspecific malaise
  • radicular pain
Other diagnostic factors

Risk factors

  • spinal cord trauma or ischemia
  • higher-level spinal cord lesion
  • extremes of age
  • narrow spinal canal
  • male sex
More risk factors

Diagnostic investigations

Investigations to consider

  • MRI spine
  • EMG
  • urodynamic studies
  • bladder ultrasound
  • renal ultrasound
  • micturition cystourethrogram
  • bone densitometry (DEXA)
  • laboratory evaluation
More investigations to consider

Treatment algorithm

ACUTE

progressive neurologic deficit

stable neurologic status

Contributors

Authors

Cristina Sadowsky, MD

Clinical Director

International Center for Spinal Cord Injury

Kennedy Krieger Institute

Associate Professor Physical Medicine and Rehabilitation

Johns Hopkins School of Medicine

Baltimore

MD

Disclosures

CS has received grant reviews from the American Institute of Biological Sciences and Grand Rounds Sinai Hospital in Baltimore, and has consulted for General Dynamics Information Tech Inc. CS is an author of a number of references cited in this topic.

Travis Edmiston, MD

Assistant Professor for Physical Medicine and Rehabilitation

International Center for Spinal Cord Injury

Kennedy Krieger Institute

Baltimore

MD

Disclosures

TE declares that he has no competing interests.

Acknowledgements

Dr Cristina Sadowsky and Dr Travis Edmiston would like to gratefully acknowledge Dr Kenneth Casey and Dr Jwalant Mehta, previous contributors to this topic.

Disclosures

KC and JM declare that they have no competing interests.

Peer reviewers

Steven Kirshblum, MD

Medical Director and Director of Spinal Cord Injury Services

Kessler Institute for Rehabilitation

West Orange

Professor

University of Medicine and Dentistry of New Jersey/New Jersey Medical School

Newark

NJ

Disclosures

SK declares that he has no competing interests.

Deborah Short, MRCP

Consultant in Rehabilitation Medicine

Robert Jones and Agnes Hunt Hospital

Oswestry

UK

Disclosures

DS declares that she has no competing interests.

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