31st G. Heiner Sell Lectureship: Secondary Medical Consequences of Spinal Cord Injury

Top Spinal Cord Inj Rehabil, 2012 · DOI: 10.1310/sci1804-354 · Published: January 1, 2012

Simple Explanation

Persons with spinal cord injury (SCI) have secondary medical consequences of paralysis and/or the consequences of extreme inactivity. The metabolic changes that result from reduced activity include insulin resistance with carbohydrate disorders and dyslipidemia. A higher prevalence of coronary artery calcification was found in persons with SCI than that in matched able-bodied controls. A depression in anabolic hormones, circulating testosterone and growth hormone, has been described. Bowel dysmotility affects all segments of the gastrointestinal tract, with an interest in better defining and addressing gastroesophageal reflux disease and difficulty with evacuation.

Study Duration

Not specified

Participants

Persons with spinal cord injury

Evidence Level

Not specified

Key Findings

1
Individuals with higher spinal lesions have both restrictive and obstructive airway disease.
2
Persons with spinal lesions above the 6th thoracic level lack both cardiac and peripheral vascular mechanisms to maintain blood pressure, and they are frequently hypotensive, with even worse hypotension with upright posture.
3
Persistent and/or orthostatic hypotension may predispose those with SCI to cognitive impairments.

Research Summary

Individuals with SCI have a myriad of medical consequences related to denervation with muscle paralysis and/or autonomic dysfunction, marked adverse soft tissue and skeletal body composition changes, and involuntary and extreme sedentary lifestyles. In this report, some of the endocrine, metabolic, GI, pulmonary, autonomic-cardiovascular, and cognitive secondary manifestations of SCI were discussed. Advances have been made in improving care, but ongoing investigations will continue to provide additional insight into the pathophysiology of these clinical disorders and test potentially effective interventions to continue to improve function and reduce morbidity.

Practical Implications

Improve Bowel Management

Personalizing and providing an appropriate bowel regimen is an important part of rehabilitative management, with the goals being effective evacuation and prevention of bowel complications.

Address Hypotension

The safety and efficacy of anti-hypotensive agents to normalize blood pressure in persons with high level cord lesions is actively being investigated.

Consider Testosterone Replacement

Studies of hormone replacement therapy should assist in determining a possible benefit from reversing low testosterone levels in the individuals with SCI.

Study Limitations

1
Longitudinal studies of body composition after acute SCI are limited
2
scant literature exists in those with chronic SCI which address the relationship between therapeutic interventions with patient outcomes
3
limitations of ATP III guidelines when applied to individuals with SCI should be appreciated

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