Pathophysiology, Classiﬁcation and Comorbidities after Traumatic Spinal Cord Injury

J. Pers. Med., 2022 · DOI: 10.3390/jpm12071126 · Published: July 11, 2022

Spinal Cord Injury Comorbidities Physiology

Simple Explanation

After a spinal cord injury (SCI), communication between the brain and body is disrupted, leading to various dysfunctions. This includes spastic paralysis, pain, autonomic nervous system imbalances causing cardiac issues, hypotension, respiratory problems, and bowel/bladder dysfunction. The article discusses the mechanisms of traumatic SCI, current and emerging classification methods, and common health problems (comorbidities) that occur after SCI. The classification of SCI involves clinical assessments (like ISNCSCI), MRI imaging, and molecular markers to describe the injury, predict recovery, and track changes over time.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Not specified

Key Findings

1
Acute SCI pathophysiology involves primary instantaneous injury and secondary progressive injury processes, where secondary damage can be attenuated.
2
Vascular damage is an immediate consequence of SCI followed by ischemia, which can be exacerbated by neurogenic shock and lead to oxidative stress and cell damage.
3
Molecular classification using biomarkers like neurofilament and GFAP can correlate with pathophysiology, damaged structures, and signaling cascades, potentially aiding in therapeutic calibration.

Research Summary

The pathophysiology of SCI involves structural disruption, primary traumatic injury, and secondary injury mechanisms, leading to cell death, inflammation, and long-term complications. Clinical classification methods, such as the ISNCSCI, are used to assess injury severity, inform prognosis, and measure recovery over time, while MRI classification allows visualization of pathophysiological events. SCI is associated with numerous comorbidities, including functional mobility limitations, respiratory dysfunction, cardiovascular dysfunction, cardiometabolic syndrome, neuropathic pain, spasticity, neurogenic bladder and bowel, pressure injuries, bone metabolism dysfunction, sexual dysfunction, and psychosocial dysfunction.

Practical Implications

Targeted Therapeutic Strategies

Insights into pathophysiological mechanisms are essential for designing targeted therapeutic strategies and optimizing critical care practices.

Improved Clinical Trial Design

Methods for stratification of acutely injured persons are critical in designing clinical trials and establishing therapeutic proof of concept.

Comprehensive Comorbidity Management

Specialty care is essential to manage the many comorbidities associated with SCI, including respiratory, cardiovascular, and metabolic dysfunction.

Study Limitations

1
ISNCSCI may be compromised in early phases due to intubation or ICU stays.
2
The sensory exam of the ISNCSCI is less well-validated than the motor component.
3
Neither clinical nor MRI biomarkers provide molecular-cascade level temporal resolution.

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