Spinal Cord Transection and Spinal Shock

Spinal Cord Transection and Spinal Shock

When the spinal cord is suddenly transected in the upper neck, at first, essentially all cord functions, including the cord reflexes, immediately become depressed to the point of total silence, a reaction called spinal shock. The reason for this is that normal activity of the cord neurons depends to a great extent on continual tonic excitation by the discharge of nerve fibers entering the cord from higher centers, particularly discharge trans-mitted through the reticulospinal tracts, vestibulospinal tracts, and corticospinal tracts.

After a few hours to a few weeks, the spinal neurons gradually regain their excitability. This seems to be a natural characteristic of neurons everywhere in the nervous system—that is, after they lose their source of facilitatory impulses, they increase their own natural degree of excitability to make up at least partially for the loss. In most nonprimates, excitability of the cord centers returns essentially to normal within a few hours to a day or so, but in human beings, the return is often delayed for several weeks and occasionally is never complete; conversely, sometimes recovery is excessive, with resultant hyperexcitability of some or all cord functions.

Some of the spinal functions specifically affected during or after spinal shock are the following:

1.     At onset of spinal shock, the arterial blood pressure falls instantly and drastically—sometimes to as low as 40 mm Hg—thus demonstrating that sympathetic nervous system activity becomes blocked almost to extinction. The pressure ordinarily returns to normal within a few days, even in human beings.

2. All skeletal muscle reflexes integrated in the spinal cord are blocked during the initial stages of shock. In lower animals, a few hours to a few days are required for these reflexes to return to normal; in human beings, 2 weeks to several months are sometimes required. In both animals and humans, some reflexes may eventually become hyperexcitable, particularly if a few facilitatory pathways remain intact between the brain and the cord while the remainder of the spinal cord is transected. The first reflexes to return are the stretch reflexes, followed in order by the progressively more complex reflexes: flexor reflexes, postural antigravity reflexes, and remnants of stepping reflexes.

3.The sacral reflexes for control of bladder and colon evacuation are suppressed in human beings for the first few weeks after cord transection, but in most cases they eventually return.