Chronic spinal cord m m
injury
m
Straight to the point of care
m m m m m
Lastm updated:m Decm 04, m 2018
, Table of Contents
m m
Overview 3
Sum m ary 3
Definition 3
Theory 4
Epidemiology 4
Aetiology 4
Pathophysiology 4
Cl assi fi cati on 6
Casem history 7
Diagnosis 8
Approach 8
Historym andm exam 12
Risk m factors 14
Investigations 16
Differentials 16
Management 17
Approach 17
Treatment m algorithm m overview 20
Treatmentm algorithm 21
Emerging 29
Primarym prevention 29
Secondarym prevention 30
Patientm discussions 30
Follow m up 31
Monitoring 31
Complications 32
Prognosis 33
Guidelines 34
Treatmentm guidel ines 34
Online m resources 35
References 36
Images 47
Disclaimer 48
,Chronicm spi nal m cordm injury Overview
Summary
Anmunderstanding mof mthemissues mrelated mtomchronic mspinalmcord minjury mshould mcommencemfrommanmapprecia
tionmof mthemevents mthat mcaused mthemprimary minjury.
OVERVIEW
Primary minjury mresults mf rommacutemmechanicalmtrauma, mcompressionmby mamspace-
occupying mlesion, mormamvascularminsult. mTheminjury mmay mbemexacerbated mby mischaemiamorminf lammation.
Themaimmof mdiagnosis mis mtomcaref ully massess mthemextent mofmneurologicalminjury, mthemdegreemofmresidualmsens
ory mand mmotormf unction, mand mto midentif y mcomplications.
Commonmassociated mproblems mincludembladdermormbowelmdysfunction, mconstipation, mneurogenic mpain, mgait m
disturbance, mcontractures, msexualmdysf unction, mautonomic mdysref lexia, mand mdevelopment mof mamsyrinx.
Management minvolves mintensivemrehabilitationmto moptimisemmobility mand mhand mfunction, mpreventionmofmcomp
lications, mbladdermand mbowelmmanagement, mand manalgesia. mSurgicalmdecompressionmmay mbemrequired mformp
rogressivemneurologicalmdef icits.
Fullmrecovery mof mneurologicalmfunctionmismunlikely, mand mthemoutcomemdepends monmthemresidualmfunctionmandm
themsuccess mof mrehabilitation. mPatients mhavemamdecreased mlif emexpectancy mcompared mwithmthemgeneralmpopu
lation.
Complications mincludemdysphagia, mDVT, mcontractures, mpressuremsores, morthostatic mhypotension, mheterotopic
m ossif ication, mdependent moedema, mand mosteoporosis.
Definition
Chronic mspinalmcord minjury mref ers mto mampermanent mand/ormprogressiveminterruptionminmthemconductionmof mim
pulses macross mthemneurons mand mtracts mofmthemspinalmcord. mIt mmay mbemduemtommechanicalmdistortionmormvasc
ularmischaemiamof mthemspinalmcord marising mf rommtrauma, mtumour, minf ectionmormothermspace-
occupying mlesions.
Themtermmis mgenerally mused mwhenmelements mof mspinalmcord minjury mhavembeenmpresent mf ormat mleast m1myear. m
Commensuratemneurologicalmdef icits moccurmthat mmay mbemstablemormprogressivemand mlead mto mdisabilitymwithms
pasticity, mjoint mcontractures, msensory mchanges, mand msphinctermand mlocomotionmabnormalities.
BMJ mBestmPracticemtopics maremregularlymupdatedmandmthemmostmrecentmversionmofmthemt
opicsmcanmbemfoundmonmbestpractice.bmj.comm.mUsemofmthismcontentmis msubjectmtomourmdi
sclaimer m(.mUsemofmthis mcontentmismsubjectmtomour) m.m©mBMJmPublishingmGroupmLtdm2021.
mAll mrights mreserved.
, This mPDFmofmthemBMJmBestmPracticemtopicmismbasedmon mthemwebmversion mthatmwasmlastmupdated:mDecm04,m2018.
3
BMJ mBestmPracticemtopics maremregularlymupdatedmandmthemmostmrecentmversionmofmthemt
opicsmcanmbemfoundmonmbestpractice.bmj.comm.mUsemofmthismcontentmis msubjectmtomourmdi
sclaimer m(.mUsemofmthis mcontentmismsubjectmtomour) m.m©mBMJmPublishingmGroupmLtdm2021.
mAll mrights mreserved.
injury
m
Straight to the point of care
m m m m m
Lastm updated:m Decm 04, m 2018
, Table of Contents
m m
Overview 3
Sum m ary 3
Definition 3
Theory 4
Epidemiology 4
Aetiology 4
Pathophysiology 4
Cl assi fi cati on 6
Casem history 7
Diagnosis 8
Approach 8
Historym andm exam 12
Risk m factors 14
Investigations 16
Differentials 16
Management 17
Approach 17
Treatment m algorithm m overview 20
Treatmentm algorithm 21
Emerging 29
Primarym prevention 29
Secondarym prevention 30
Patientm discussions 30
Follow m up 31
Monitoring 31
Complications 32
Prognosis 33
Guidelines 34
Treatmentm guidel ines 34
Online m resources 35
References 36
Images 47
Disclaimer 48
,Chronicm spi nal m cordm injury Overview
Summary
Anmunderstanding mof mthemissues mrelated mtomchronic mspinalmcord minjury mshould mcommencemfrommanmapprecia
tionmof mthemevents mthat mcaused mthemprimary minjury.
OVERVIEW
Primary minjury mresults mf rommacutemmechanicalmtrauma, mcompressionmby mamspace-
occupying mlesion, mormamvascularminsult. mTheminjury mmay mbemexacerbated mby mischaemiamorminf lammation.
Themaimmof mdiagnosis mis mtomcaref ully massess mthemextent mofmneurologicalminjury, mthemdegreemofmresidualmsens
ory mand mmotormf unction, mand mto midentif y mcomplications.
Commonmassociated mproblems mincludembladdermormbowelmdysfunction, mconstipation, mneurogenic mpain, mgait m
disturbance, mcontractures, msexualmdysf unction, mautonomic mdysref lexia, mand mdevelopment mof mamsyrinx.
Management minvolves mintensivemrehabilitationmto moptimisemmobility mand mhand mfunction, mpreventionmofmcomp
lications, mbladdermand mbowelmmanagement, mand manalgesia. mSurgicalmdecompressionmmay mbemrequired mformp
rogressivemneurologicalmdef icits.
Fullmrecovery mof mneurologicalmfunctionmismunlikely, mand mthemoutcomemdepends monmthemresidualmfunctionmandm
themsuccess mof mrehabilitation. mPatients mhavemamdecreased mlif emexpectancy mcompared mwithmthemgeneralmpopu
lation.
Complications mincludemdysphagia, mDVT, mcontractures, mpressuremsores, morthostatic mhypotension, mheterotopic
m ossif ication, mdependent moedema, mand mosteoporosis.
Definition
Chronic mspinalmcord minjury mref ers mto mampermanent mand/ormprogressiveminterruptionminmthemconductionmof mim
pulses macross mthemneurons mand mtracts mofmthemspinalmcord. mIt mmay mbemduemtommechanicalmdistortionmormvasc
ularmischaemiamof mthemspinalmcord marising mf rommtrauma, mtumour, minf ectionmormothermspace-
occupying mlesions.
Themtermmis mgenerally mused mwhenmelements mof mspinalmcord minjury mhavembeenmpresent mf ormat mleast m1myear. m
Commensuratemneurologicalmdef icits moccurmthat mmay mbemstablemormprogressivemand mlead mto mdisabilitymwithms
pasticity, mjoint mcontractures, msensory mchanges, mand msphinctermand mlocomotionmabnormalities.
BMJ mBestmPracticemtopics maremregularlymupdatedmandmthemmostmrecentmversionmofmthemt
opicsmcanmbemfoundmonmbestpractice.bmj.comm.mUsemofmthismcontentmis msubjectmtomourmdi
sclaimer m(.mUsemofmthis mcontentmismsubjectmtomour) m.m©mBMJmPublishingmGroupmLtdm2021.
mAll mrights mreserved.
, This mPDFmofmthemBMJmBestmPracticemtopicmismbasedmon mthemwebmversion mthatmwasmlastmupdated:mDecm04,m2018.
3
BMJ mBestmPracticemtopics maremregularlymupdatedmandmthemmostmrecentmversionmofmthemt
opicsmcanmbemfoundmonmbestpractice.bmj.comm.mUsemofmthismcontentmis msubjectmtomourmdi
sclaimer m(.mUsemofmthis mcontentmismsubjectmtomour) m.m©mBMJmPublishingmGroupmLtdm2021.
mAll mrights mreserved.
