Herein we present a case in which a paraplegic spina bifida patient presenting with symptomatic spinal retethering experienced autonomic dysreflexia following an elective spinal cord transection. [ncbi.nlm.nih.gov]

Cord injury usually follows breech presentation, the lesion is in the lower cervical or upper thoracic segments, and results from excessive traction. [adc.bmj.com]

A 53-year-old man presented to the emergency department with a glasgow coma scale score of 15 after sustaining a stab wound to the posterior neck. At presentation, he was unable to move his legs and he was unable to feel from the chest downward. [onlinejets.org]

• Falling

  After food ingestion, there was no fall in BP in tetraplegics or in controls. HR did not change in either group. [ncbi.nlm.nih.gov]

  When spinal cord transection occurs suddenly, for example as the result of a fall from a horse, the initial phase is known as spinal shock. [wisegeekhealth.com]

  According to the National Spinal Cord Injury Association (NSCIA), not every spinal cord injury results from a motor vehicle accident (42%), violence (24%), falling (22%), or sports (8%). Occasionally SCIs are caused by diseases such as polio. [spineuniverse.com]

  Take precautions to avoid falls around your home. Keep firearms unloaded and locked away. [hopkinsmedicine.org]

• Disability

  It is a cause of very serious disability and requires much more research. It should be a focus of treatment strategies. [books.google.de]

  Spinal cord disorders can cause permanent severe neurologic disability. For some patients, such disability can be avoided or minimized if evaluation and treatment are rapid. [merckmanuals.com]

  […] also known as the Babinski reflex ) Spastic bladder : involuntary urination caused by contractions Possibly erectile dysfunction in men Evaluation and diagnosis of spinal cord injuries Stabilize patient ABCDE approach ( airway, breathing, circulation, disability [amboss.com]

  SCI is a common cause of permanent disability and death in children and adults. [urmc.rochester.edu]

  It would have been easy for my family to molly-coddle me, but they never treated me like I was disabled or different in any way. [telegraph.co.uk]

• Asymptomatic

  Common Complications Urinary Tract Infections Asymptomatic bacteruria occurs in a majority of patients with SCIs during pregnancy. The incidence of lower urinary tract infections and pyelonephritis also is increased. [acog.org]

  […] spinal shock neurogenic shock associated injuries closed head injuries noncontiguous spinal fractures vertebral artery injury risk factors for vertebral artery injury include atlas fractures facet dislocations most people with unilateral injury remain asymptomatic [orthobullets.com]

  Traumatic SCI can result in contusion, compression, or stretch injury. [4] It is a major risk of many types of vertebral fracture. [68] Pre-existing asymptomatic congenital anomalies can cause major neurological deficits, such as hemiparesis, to result [en.wikipedia.org]

• Surgical Procedure

  Descriptions of surgical procedures include patient monitoring and assessments that happen before, during, and after. [books.google.com]

  We explored the region of the principal sensory nucleus of thalamus (Vc) during stereotactic surgical procedures for treatment of patients with pain after spinal cord transection (n = 23). [ncbi.nlm.nih.gov]

  The day after her accident, Teresa had an L1 corpectomy, a surgical procedure that involves the removal of all or part of the intervertebral disc, combined with placement of a titanium cylindrical cage, an interbody fusion device, and a z-rod from the [orthoinfo.aaos.org]

• Fever

  Your healthcare provider might advise you to call them if you have problems such as: Skin sores or infections Trouble breathing Fever, cough, or other signs of infection Severe headache Not urinating regularly or having severe diarrhea or constipation [hopkinsmedicine.org]

  Pneumonia can be accompanied by shortness of breath, fever, and anxiety. [en.wikipedia.org]

• Respiratory Distress

  In addition, respiratory distress or hypotension due to spinal shock may lead to a confusional state that may deviate attention to a brain lesion, prevent immediate diagnosis, and further contribute to worsening of the spinal lesion. [emedicine.medscape.com]

  During the hospital course, the patient developed ileus and subsequently developed respiratory failure. The patient died on day 7 of his hospital stay from acute respiratory distress syndrome. Figure 1: MRI was performed on the day of trauma. [onlinejets.org]

  The resultant catecholamine release and vasoconstriction lead to hypertension associated with headache, bradycardia, tachycardia, cardiac arrhythmia, sweating, flushing, tingling, nasal congestion, piloerection, and, occasionally, respiratory distress [acog.org]

  Potential lung complications include aspiration, pneumonia, acute respiratory distress syndrome, atelectasis, ventilation-perfusion mismatch and decreased coughing with retention of secretions. [patient.info]

• Diarrhea

  This may help prevent diarrhea. Drink several glasses of water each day. This can prevent constipation. Medications. [webmd.com]

  Your healthcare provider might advise you to call them if you have problems such as: Skin sores or infections Trouble breathing Fever, cough, or other signs of infection Severe headache Not urinating regularly or having severe diarrhea or constipation [hopkinsmedicine.org]

• Hypotension

  Abstract In sympathetic denervation due to primary autonomic failure, ingestion of food causes a fall in blood pressure (BP) and exacerbates postural hypotension. [ncbi.nlm.nih.gov]

  In lower thoracic and lumbar/sacral cord lesions, hypotension is not present but urinary and bowel retention are. [emedicine.medscape.com]

  Hypotension, temperature dysregulation, venous stasis, and autonomic dysregulation (AD) may occur. Hypotension. [americannursetoday.com]

  Patient may be quite vasodilated and hypotensive. This phase of neurogenic shock can last up to several weeks. Hypotension should be treated to prevent secondary poor perfusion of the spinal cord. [rch.org.au]

• Fracture

  […] teardrop fracture Vertical compression Burst fracture, e.g. [radiologyassistant.nl]

  Physical Findings Patients with a spine fracture and spinal cord injury will typically demonstrate profound tenderness and spasm over the injured region. There is often visible swelling and ecchymosis (bruising) over the fracture site. [uscspine.com]

  One patient had chip fracture of anteroinferior part of C4 vertebral body and two had fractures of tips of spinous processes. MRI study was done in 16 cases and computed tomography (CT) is one. [neurologyindia.com]

  She suffered a burst fracture in her L1 vertebra (lower back) and an incomplete injury to her spinal cord. A burst fracture occurs when the vertebrae is crushed in all directions, and is much more serious than a compression fracture. [orthoinfo.aaos.org]

  The identification of significant cord transection can potentially contraindicate surgery. spinal cord injury traumatic spinal cord injury cervical spine fractures Promoted articles (advertising) [radiopaedia.org]

• Contusion

  Widely used animal models of SCI are complete or partial transection or experimental contusion and compression, with both bearing controversy as to which one more appropriately reproduces the human SCI functional consequences. [ncbi.nlm.nih.gov]

  Cord injuries usually fall into one of the following categories: Contusions, or bruising of the spinal cord Compression injuries that place pressure on the cord Lacerations or tearing (eg, from a bullet) Central Cord Syndrome Complete severing (rare) [spineuniverse.com]

  This could come in the form of a bruise (a contusion) or a complete tear (a transection). [birthinjuryguide.org]

  Football players are especially susceptible to spinal concussions and spinal cord contusions. The latter may produce neurological symptoms including numbness, tingling, electric shock-like sensations and burning in the extremities. [aans.org]

  The primary cause is the initial mechanical impact, compression, and contusion resulting in damage to nerve cells, myelin, blood vessels, and supporting bone structures. [uscspine.com]

• Back Pain

  Symptoms Patients with associated spine fractures typically have significant, localized neck or back pain. Patients with incomplete spinal cord injuries may complain of pain in other areas and not notice the severity of neck of back pain. [uscspine.com]

  However, less than 0.1% of people with back pain who visit their general practitioner have spinal metastases [ 3 ]. [patient.info]

  It can cause low back pain, weakness or paralysis in the lower limbs, loss of sensation, bowel and bladder dysfunction, and loss of reflexes. Unlike in conus medullaris syndrome, symptoms often occur on only one side of the body. [en.wikipedia.org]

• Muscle Spasticity

  spasticity (increased muscle tone) management Medications and alternative methods of managing pain and spasticity Psychological counseling Identifying problems and solutions for thinking, behavioral, and emotional issues Family support Assistance with [urmc.rochester.edu]

  Spasticity can reduce venous pooling and stabilize the thoracic and abdominal muscles used in respiration. [americannursetoday.com]

• Joint Dislocation

  Causes of spinal cord compression Trauma (including car accidents, falls and sports injuries): There is usually either vertebral fracture (most common in cervical vertebrae) or facet joint dislocation. [patient.info]

• Quadriplegia

  Level of Injury Possible Impairment Rehabilitation Potential C2 - C3 Usually fatal as a result of inability to breathe Totally dependent for all care C4 Quadriplegia and breathing difficulty Dependent for all cares; usually needs a ventilator C-5 Quadriplegia [urmc.rochester.edu]

  Transection of Spinal Cord A Rare Obstetrical Complication of Cephalic Delivery Abstract A newborn infant, delivered following mid-forceps rotation, presented with apnoea, anaesthesia below the level of the mid-neck, and flaccid quadriplegia. [adc.bmj.com]

  Quadriplegia is defined as profound or complete loss of motor function (strength) of the arms and legs. [uscspine.com]

  Complete spinal cord transection syndrome In the acute phase, the classic syndrome of complete spinal cord transection at the high cervical level consists of respiratory insufficiency; quadriplegia with upper and lower extremity areflexia; anesthesia [emedicine.medscape.com]

  Firooznia H, Jung H, Rafii M et al : Quadriplegia after minor trauma. The role of preexisting spinal stenosis. Surg Neurol 1985; 23 : 165 -168. 2. [neurologyindia.com]

• Hyperreflexia

  It presents with spastic paresis, hyperreflexia, and continued sensory loss. Acute stabilization, a thorough neurological examination, and imaging is required for adequate diagnosis. [amboss.com]

  When the stage of spinal shock passes, the typical UMN picture within hyperreflexia and spastic paralysis below the level of the injury supervenes. Clinical symptoms and signs of spinal cord transection depend on the level injured. [casemed.case.edu]

  Ipsilaterally, paralysis, loss of vibration and position sense below the level of the lesion, hyperreflexia, and an extensor toe sign are present. In addition, ipsilateral segmental anesthesia occurs at the level of the lesion. [emedicine.medscape.com]

  After days or weeks, upper motor neuron dysfunction evolves into spastic paresis (increased muscle tone, hyperreflexia, and clonus). Extensor plantar responses and autonomic dysfunction are present. [merckmanuals.com]

• Spastic Paralysis

  Characteristically there is: lower motor neuron paralysis at the level of injury upper motor neuron (or spastic) paralysis below the level of injury The degree of neurological compromise corresponds with the degree of cord transection. [radiopaedia.org]

  A change in symptoms occurs after a period of 6–8 weeks and includes spastic paralysis, recurrence of proprioceptive reflexes as hyperreflexia, and the presence of pathological reflexes (e.g., plantar reflex )! References: [1] [2] [3] [4] [amboss.com]

  When the stage of spinal shock passes, the typical UMN picture within hyperreflexia and spastic paralysis below the level of the injury supervenes. Clinical symptoms and signs of spinal cord transection depend on the level injured. [casemed.case.edu]

• Flaccid Paralysis

  It presents as a flaccid areflexic paralysis below the level of the injury with autonomic features (e.g., hypotension and bradycardia ). After some days to weeks the spinal shock wears off and a complete spinal cord injury may remain. [amboss.com]

  During this period, there is complete absence of reflex and autonomic activity below the level of the injury with flaccid paralysis. [casemed.case.edu]

  Incomplete deficit E Normal Normal Motor Normal Sensory Acute Phase Conditions Neurogenic shock Spinal shock defined as temporary loss of spinal cord function and reflex activity below the level of a spinal cord injury. characterized by flaccid areflexic [orthobullets.com]

  Signs & symptoms of acute SCI Flaccid paralysis below level of injury Loss of spinal reflexes below level of injury Loss of sensation (pain, touch, proprioception, temperature) below level of injury Loss of sweating below level of injury Loss of sphincter [rch.org.au]

• Stroke

  […] discharge reflex commonly seen following cervical and high thoracic spinal cord injury, leading to a disconnect between autonomic pathways above and below the lesion that can lead to severe complications including uncontrolled hypertension, bradycardia, stroke [ncbi.nlm.nih.gov]

  […] disease or ulcerative colitis ) Nerve damage (due to diabetes, spinal cord injury, multiple sclerosis, or other conditions) Radiation damage to the rectum (such as after treatment for prostate cancer ) Cognitive (thinking) impairment (such as after a stroke [webmd.com]

  Additional resources The National Institute of Neurological Disorders and Stroke offers this information: " Spinal Cord Injury: Hope Through Research ." Find help and support at the National Spinal Cord Injury Association. [livescience.com]

  Archived (PDF) from the original on 2015-12-08. ^ a b c d e f g h i j k Office of Communications and Public Liaison, National Institute of Neurological Disorders and Stroke, eds. (2013). Spinal Cord Injury: Hope Through Research. [en.wikipedia.org]

• Sexual Dysfunction

  It contains a compilation of what is known about bladder, cardiovascular, bowel and sexual dysfunction after spinal cord injury, as it relates to the changes within the autonomic nervous system control of these functions. [books.google.de]

  Conus Medullaris Transection Injury to the conus medullaris results in prominent bowel, bladder, and sexual dysfunction. [casemed.case.edu]

  In the acute phase, physicians must be vigilant in cases of sudden onset of quadriparesis (with or without respiratory distress); paraparesis; loss of sensation or bowel or bladder control; sexual dysfunction; or symptoms of neurogenic shock such as lightheadedness [emedicine.medscape.com]

  dysfunction Symptoms do not always begin immediately. [columbiaspine.org]

  dysfunction The symptoms of SCI may resemble other medical conditions or problems. [urmc.rochester.edu]

• Urinary Retention

  However, it mimics conus medullaris syndrome, causing distal leg paresis and sensory loss in and around the perineum and anus (saddle anesthesia), as well as bladder, bowel, and pudendal dysfunction (eg, urinary retention, urinary frequency, urinary or [merckmanuals.com]

  During the initial stage of spinal shock after cord transection at any level, reflex emptying of the bladder may be lost, resulting in urinary retention and bladder distention. [casemed.case.edu]

  In lower thoracic and lumbar/sacral cord lesions, hypotension is not present but urinary and bowel retention are. [emedicine.medscape.com]

  The latter can lead to neurogenic shock, paralytic ileus, aspiration, urinary retention, priapism and loss of thermoregulation. Clinical features depend upon the extent and rate of development of cord compression. [patient.info]

  Genitourinary management A patient in neurogenic shock experiences abrupt loss of voluntary muscle control and reflexes, resulting in acute urinary retention. [americannursetoday.com]

• Urinary Incontinence

  Male Stress Urinary Incontinence surgery Female Stress Urinary Incontinence PHARMACEUTICAL TREATMENT Your doctor may prescribe medications to improve bladder function, such as reduce bladder contractions, lower urinary frequency, improve loss of bladder [nafc.org]

  It is common to experience sexual dysfunction after injury, as well as dysfunction of the bowel and bladder, including fecal and urinary incontinence. [9] It is also possible for the bladder to fail to empty, leading to a potentially harmful buildup of [en.wikipedia.org]

Adult Sprague-Dawley rats (n=56) transected at T8-9 had one of five treatments beginning 7 days after transection: Tx (transection only), Tx+Ex, Tx+DOPA, Tx+Ex+DOPA, and control (Ctl, no treatment) groups. [ncbi.nlm.nih.gov]

It should be a focus of treatment strategies. [books.google.de]

Combinatorial treatment generated motor axon regeneration beyond both C5 hemisection and T3 complete transection sites. [jneurosci.org]

Often, more than one treatment method may be required to control symptoms. Nonsurgical treatments are often recommended as initial treatment for bowel incontinence. These include: Diet. [webmd.com]

Treatment and prognosis The role of acute MRI is usually to assess for the presence of treatable acute pathologies such as an epidural hematoma or cord compression, which can be targeted by surgical decompression. [radiopaedia.org]

Disease monographs include definition, incidence and prevalence, etiology, laboratory results, clinical manifestations, treatment, anesthetic considerations, and prognosis. [books.google.com]

Prognosis The spinal cord has very limited powers of regeneration. Prognosis for neurological deficit depends on the magnitude of the spinal cord damage present at the onset. [patient.info]

According to the National Institutes of Health (NIH), the prognosis of spinal cord damage will depend on if the injury was complete or incomplete. [birthinjuryguide.org]

Glasis Post 1 Unfortunately at this time spinal cord injuries mean a pretty gloomy prognosis. An injury to the spinal cord generally results in some sort of permanent impairment regardless of the treatment. [wisegeekhealth.com]

Disease monographs include definition, incidence and prevalence, etiology, laboratory results, clinical manifestations, treatment, anesthetic considerations, and prognosis. [books.google.com]

References: [1] [2] [3] Complete spinal cord injury Etiology Incomplete spinal cord syndromes may develop into complete spinal cord lesions Trauma (complete transection) Spinal tumors, multiple sclerosis, or myelitis Extradural pathologies (e.g., spinal [amboss.com]

The most common etiologies include trauma ; compression from tumor, hematoma, or abscess ; or transverse myelitis (viral, post-viral, or demyelinative), among other causes. [casemed.case.edu]

Wilder BL : Hypothesis: The etiology of midcervical quadriplegia after operation with patient in the sitting position. Neurosurgery 1982; 11 : 530 -531. 7. [neurologyindia.com]

He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]

Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine 2001;26S:2. Tator CH, Duncan EG, Edmonds VE, et al. Changes in epidemiology of acute spinal cord injury from 1947 to 1981. Surg Neurol 1993;40:207. [uscspine.com]

Clinical Epidemiology. 6 : 309–31. doi : 10.2147/CLEP.S68889. PMC 4179833. PMID 25278785. ^ Devivo MJ (May 2012). "Epidemiology of traumatic spinal cord injury: trends and future implications". Spinal Cord. 50 (5): 365–72. doi : 10.1038/sc.2011.178. [en.wikipedia.org]

Introduction Epidemiology incidence 11,000 new cases/year in US 34% incomplete tetraplegia central cord syndrome most common 25% complete paraplegia 22% complete tetraplegia 17% incomplete paraplegia demographics bimodal distribution young individuals [orthobullets.com]

Organized by disease, the new edition of this popular guide has been completely revised and updated to reflect the latest information on definition, current pathophysiology, significant pre-, intra-, and postoperative factors of the disease process, anesthetic [books.google.de]

Pathophysiology and pharmacologic treatment of acute spinal cord injury. Spine J 2004;4:451. Rizzolo SJ, Vacarro AR, Cotler JM: Cervical spine trauma. Spine 1994;19:2288. Sekhon LH, Fehlings MG. [uscspine.com]

Most dramatic effects noted in the first few weeks with most patients stabilizing in 7-10 days SCI pathophysiology & presentation Complete/incomplete injury A complete SCI results in loss of all motor and sensory function below the level of injury (AIS [rch.org.au]

Pathophysiology primary injury damage to neural tissue due to direct trauma irreversible secondary injury injury to adjacent tissue due to decreased perfusion lipid peroxidation free radical / cytokines cell apoptosis methylprednisone used to prevent [orthobullets.com]

"Epidemiology, demographics, and pathophysiology of acute spinal cord injury". Spine. 26 (24 Suppl): S2–12. doi : 10.1097/00007632-200112151-00002. [en.wikipedia.org]

The authors describe the case of an 11-year-old girl with lumbar myelomeningocele and worsening thoracolumbar scoliosis who underwent a T11-L5 fusion and spinal transection to prevent tethering. [ncbi.nlm.nih.gov]

With no cure for SCI available, prevention remains key. To help prevent behavior that can lead to this devastating injury, educate the public on how to prevent SCIs. [americannursetoday.com]

This may help prevent diarrhea. Drink several glasses of water each day. This can prevent constipation. Medications. [webmd.com]

The spinous process and transverse process would prevent a knife blade from crossing the midline before entering the ligamentum flavum. [onlinejets.org]