Revisit Spinal Shock: Pattern of Reflex Evolution during Spinal Shock

Korean J Neurotrauma, 2018 · DOI: https://doi.org/10.13004/kjnt.2018.14.2.47 · Published: August 20, 2018

Simple Explanation

Spinal shock is the temporary loss of reflexes and muscle tone below the level of a spinal cord injury. It occurs immediately after the injury and can last for days to months. The definition and how reflexes recover during spinal shock are still debated. Clinicians use different signs, like the return of certain reflexes, to mark the end of spinal shock. The exact causes of spinal shock are not fully understood, but it involves changes in how nerve signals are transmitted in the spinal cord.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review Article

Key Findings

1
The traditional view that reflexes return in a caudo-rostral sequence (from the tail to the head) after spinal shock may not be accurate.
2
Polysynaptic cutaneous reflexes (like the delayed plantar response) might appear before monosynaptic deep tendon reflexes (like knee jerk).
3
A delayed plantar response, which requires a strong stimulus, could be the first reflex to return after a spinal cord injury.

Research Summary

Spinal shock is characterized by a temporary loss of reflexes and muscle tone below the injury level, with its resolution marked by the return of reflex activity, transitioning to spasticity over time. The pathophysiology of spinal shock involves complex mechanisms like synaptic changes, neurotransmitter imbalances, and alterations in descending pathways. Clinical observations suggest that the pattern of reflex recovery is individualized, with polysynaptic cutaneous reflexes potentially preceding monosynaptic deep tendon reflexes, challenging the traditional caudorostral recovery pattern.

Practical Implications

Re-evaluate Spinal Shock Definition

The definition of spinal shock should be reconsidered since all reflexes are rarely absent, even in complete injuries.

Reflex Assessment Post-SCI

Assess cutaneous polysynaptic reflexes alongside deep tendon reflexes to monitor recovery after spinal cord injury.

Personalized Rehabilitation Strategies

Tailor rehabilitation strategies based on individual reflex recovery patterns, considering age and the presence of pre-existing conditions.

Study Limitations

1
Limited recent research on the underlying mechanisms of spinal shock.
2
Lack of uniform consensus on defining the cessation of spinal shock.
3
Clinical observation of reflex change since spinal cord injury in humans can not be an easy task.

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