From the Guidelines
Spinal cord injury (SCI) complications can be effectively managed with comprehensive, specialized care from rehabilitation teams, prioritizing prevention of secondary disabilities and focusing on early detection and treatment of potential issues such as respiratory problems, autonomic dysreflexia, pressure ulcers, and osteoporosis, as recommended by the most recent guidelines 1.
Overview of SCI Complications
SCI complications include several serious medical issues that can develop after damage to the spinal cord. The most immediate complications are respiratory problems, particularly in high cervical injuries, which may require ventilator support. Autonomic dysreflexia is a potentially life-threatening condition where stimuli below the injury level trigger excessive sympathetic responses, causing dangerous blood pressure spikes.
Common Complications
Some common complications of SCI include:
- Pressure ulcers that develop due to immobility and decreased sensation
- Urinary tract infections that occur from catheter use and bladder dysfunction
- Deep vein thrombosis and pulmonary embolism risks that increase significantly due to immobility
- Spasticity that causes muscle stiffness and involuntary movements, often treated with medications such as baclofen or tizanidine
- Chronic pain that affects most SCI patients, requiring multimodal approaches including gabapentin, pregabalin, and physical therapy
Importance of Early Detection and Treatment
Early detection and treatment of these complications are crucial to prevent secondary disabilities and improve the quality of life for individuals with SCI. As noted in a study on the management of Guillain-Barré syndrome, recognition and adequate treatment of psychological symptoms and pain at an early stage is important because these symptoms can have a major impact on the wellbeing of patients 1.
Role of Rehabilitation Teams
Rehabilitation teams play a critical role in managing SCI complications, and their involvement should be considered as soon as the patient is medically stable, as recommended by the updated practice guideline for dual-energy x-ray absorptiometry (DXA) 1. Referral to a specialized centre should be considered for individuals with SCI to ensure they receive comprehensive care.
Additional Considerations
Additional considerations in the management of SCI complications include the risk of osteoporosis, which develops rapidly after SCI due to immobilization, and temperature regulation problems that occur from disrupted autonomic control. The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction also highlights the importance of risk stratification and delayed urodynamic studies (UDS) until the period of spinal shock has resolved 1.
From the Research
Sci Complications Overview
- Spinal cord injuries (SCI) can lead to various complications, including motor and sensory deficits, as well as instabilities of the cardiovascular, thermoregulatory, and broncho-pulmonary systems 2.
- Disturbances of the urinary and gastrointestinal systems, sexual dysfunction, and psychological stress are also common complications of SCI 2, 3.
Acute Complications
- Neurogenic shock, bradyarrhythmias, hypotension, ectopic beats, abnormal temperature control, and disturbance of sweating are frequent complications of cervical and high thoracic SCI 2.
- Autonomic dysreflexia is a life-threatening complication that can occur in patients with SCI, characterized by an abrupt, uncontrolled sympathetic response 2.
- Respiratory function is often disturbed in tetraplegia, and pulmonary complications are a primary cause of short and long-term morbidity and mortality 2, 4.
Chronic Complications
- Patients with SCI are at a higher risk of venous thromboembolism and pressure ulcers due to physical inactivity and altered haemostasis 2, 4.
- Spasticity and pain are frequent complications that need to be addressed in patients with SCI 2.
- Psychological stress associated with SCI can lead to anxiety and depression, highlighting the importance of proper management and support 2, 3.
Management and Treatment
- Maintenance of adequate perfusion and oxygenation is crucial in the acute setting, and a mean arterial pressure >85-90 mm Hg should be kept for at least 1 week 4.
- Computed tomography and magnetic resonance imaging are essential for evaluating the spinal column and neural elements in patients with SCI 4.
- Measures to prevent pulmonary emboli, pressure ulcers, and nutritional support should be a mainstay of treatment 4, 5.