From the Guidelines
The best method to diagnose spinal shock (Spinal Cord Injury, SCI) is through a combination of clinical examination and imaging studies, with multidetector-row computerised tomography (MDCT) being the preferred initial imaging modality, as it approaches 100% sensitivity for detecting unstable spinal injuries 1. When diagnosing spinal shock, it is essential to begin with a comprehensive neurological examination that demonstrates areflexia (absence of reflexes) below the level of spinal cord injury, along with flaccid paralysis and loss of autonomic function.
- Assess deep tendon reflexes, which will be absent during spinal shock
- Check for hypotension and bradycardia due to loss of sympathetic tone
- Test for flaccid paralysis by examining muscle tone and strength below the injury level
- Assess for autonomic dysfunction by monitoring for priapism in males, urinary retention, and loss of thermoregulation
- Perform a rectal examination to check for loss of anal tone and bulbocavernosus reflex Imaging studies, such as MDCT, should be used to identify the spinal cord injury, and CT of the entire spine in obtunded blunt trauma patients (OBTPs) using a modern MDCT is strongly recommended 1.
- MRI may be used if there is a positive neurological examination referable to the spinal cord (myelopathy) 1
- It is crucial to have images reported by a senior radiologist who is skilled in musculoskeletal/neuro-radiology 1 Removing spinal precautions and mobilizing the patient as soon as possible is acceptable after CT and combined CT and MRI, but it is essential to be vigilant for developing neurological signs despite a spine having been ‘cleared’ 1.
From the Research
Diagnostic Methods for Spinal Shock
The diagnosis of spinal shock, a condition resulting from spinal cord injury (SCI), involves various methods to assess the extent of the injury and its impact on the patient's physiology. Some of the key diagnostic approaches include:
- Clinical assessment and classification of SCI, utilizing tools such as the American Spinal Injury Association impairment scale, Spinal Cord Independence Measure, and International Spinal Cord Injury Basic Pain Data Set 2
- Imaging examinations, with magnetic resonance imaging (MRI) being the most indicated for evaluating patients with symptomatic SCI 2
- Radiographs, computed tomography (CT), and MRI for assessing spinal trauma and instability 3
- Electrophysiologic tests, such as somatosensory evoked potentials, to reflect changes caused by spinal shock 4
Imaging Modalities
The choice of imaging modality depends on the specific clinical scenario and the information needed to guide management. The options include:
- Radiography for initial assessment of spinal alignment and fractures
- CT for detailed evaluation of bony structures and detection of spinal instability
- MRI for assessment of soft tissue injuries, spinal cord compression, and neural element damage 3, 5
Clinical Evaluation
Clinical evaluation is crucial in the diagnosis and management of spinal shock. This includes:
- Assessment of sensory, motor, and reflex function to determine the level and severity of the injury
- Monitoring of vital signs, such as blood pressure and heart rate, to guide emergency care and early management 2
- Evaluation of autonomic functions, such as bladder and bowel control, to assess the extent of spinal cord damage 4