Spinal Shock: Clinical Pearls

Abstract

Spinal shock is a clinical manifestation following injury to the spinal cord resulting from multiple mechanisms. It is a complex phenomenon with flaccid paralysis, absent anal wink, and bulbocavernosus reflex. Management strategy for such patients includes rapid evaluation and treatment strategies to minimize the impact of secondary spinal cord injury. The advanced trauma life support (ATLS) guidelines provide the basis for rapid assessment and stabilization of A (Airway), B (Breathing), and C (Circulation) before dealing with the neurological deficits under the primary survey. The emergence of better radiological investigations has been pivotal in categorizing spinal syndromes and reaching a precise diagnosis. Early initiation of treatment measures results in better neurological and functional recovery with minimal residual deficits. The role of steroids in spinal shock has been a highly debated topic, and the timing of surgery is variable, intending to eliminate the secondary injury. Clinical differentiation between neurogenic and hypovolemic shock is vital, enhancing the quality of care with realistic outcome expectations.