Elsevier

Revue Neurologique

Volume 177, Issue 5, May 2021, Pages 594-605
Revue Neurologique

International meeting of the French society of neurology 2020
Spinal cord injury: A multisystem physiological impairment/dysfunction

https://doi.org/10.1016/j.neurol.2021.02.385Get rights and content

Abstract

Spinal cord injury (SCI) is a complex disease that affects not only sensory and motor pathways below the neurological level of injury (NLI) but also all the organs and systems situated below this NLI. This multisystem impairment implies comprehensive management in dedicated SCI specialized centers, by interdisciplinary and multidisciplinary teams, able to treat not only the neurological impairment, but also all the systems and organs affected. After a brief history of the Spinal Cord Medicine, the author describes how to determine the level and severity of a SCI based on the International Standards for Neurological Classification of Spinal Cord Injury and the prognosis factors of recovery. This article provides also a review of the numerous SCI-related impairments (except for urinary, sexual problems and pain treated separately in this issue), their principles of management and related complications.

Section snippets

Epidemiology of spinal cord injury

Estimated global SCI incidence is 40 to 80 new cases per million population per year. This means that every year, between 250,000 and 500,000 people become spinal cord injured. [1] Among these SCI lesions, it is usual to distinguish traumatic SCI (TSCI) and nontraumatic SCI (NTSCI). For TSCI, country level incidence rates vary over the world from 13 to 53 cases per million population. The leading causes of TSCI are road traffic accident, followed by falls, violence, and sports and leisure

History of the SCI (Spinal cord Injury) Medicine

Before World War II, SCI was considered to be an untreatable disease. As said by Harvey Cushing “Fully 80% died in the first few weeks in consequence of infections from bedsores and catheterization. Only those cases survived in which the spinal cord lesion was a partial one” [2]. In February 1944, a German neurosurgeon, Ludwig Guttman, who fled the Nazi regime, opened the doors of the first spinal injury center, the National Spinal Injury Center in Stoke Mandeville, United Kingdom. Ludwig

International Standards for Neurological Classification of Spinal cord Injury (ISNCSCI)

There was a need to determine precisely the neurological impairment of the spinal cord lesions, their extent, severity and changes (recovery or deterioration). Based on the work of Lowett, the Medical Research Council on the Manual Muscle Test and the works of Foerster on the sensory dermatomes, the American Spinal Injury Association (ASIA) published in 1982 the ASIA standards for neurological classification of SCI which were secondary endorsed by the ISCOS in 1992 [7]. Following subsequent

Management of respiratory dysfunction in SCI

Respiratory complications are today the leading cause of death during the first year post-injury and beyond (30%), especially in the tetraplegic population mostly due to respiratory tract infections (pneumonia and bronchopneumonia), but also to mucus plugging (atelectasis) [6]. Cervical and upper thoracic SCI dysfunction is associated with variable degrees of pulmonary dysfunction dependent on the level and the completeness of the injury. This dysfunction ranges from total impossibility of

Physiology and neuroanatomy of cardiovascular control

In able bodied subjects, both heart rate and blood pressure are controlled by a coordinated regulation of the two components of the autonomic nervous system: the sympathetic and parasympathetic. The parasympathetic control of the heart exits at the level of the brainstem via the vagus nerve and reaches the heart without traversing the spinal cord. The vagal cardiovascular responses are a decrease of heat rate and heart contractility, and do not extend to the peripheral vasculature except in

Pressures ulcers

A pressure ulcer (PU) is defined as a localized injury to the skin and/or the underlying tissue usually over a bony prominence, as a result of pressure in combination with shear [27].

Neurogenic bowel dysfunction in SCI

Bowel dysfunction in one of the most prevalent secondary health conditions affecting the SCI individual's quality of life. Improving bowel dysfunction is rated as one of the highest priorities among individuals with SCI [32]. The extrinsic innervation of the gut is well known with parasympathetic input to the proximal colon through the vagus nerve (down to the splenic flexure) and to the whole colon and the anorectum via the sacral roots (S2-S4); the role of the parasympathetic activity is to

Spasticity

Spasticity is a common and debilitating secondary health condition following spinal cord damage. Spasticity has been reported to affect 71% of people with chronic spinal injury including muscle stiffness and spasms respectively in 91% and 94% of the cases [37]. In a recent published survey including 1436 participants, 51.7% reported moderate to severe spasticity problems [38]. Spasticity in SCI causes discomfort, pain, fatigue and sleep disturbances and may affect ambulation, prehension,

Joint contractures

Joint contractures are an insidious comorbidity in a spinal cord injury that leads to pain, deformity, loss of function and ultimately contribute to decreased levels of independence and overall lower quality of life. Tetraplegic patients are especially exposed and in this specific population, the presence of joint contractures may exclude individuals or limit potential functional gains from upper extremity surgical reconstruction such as tendon transfers. Shoulder joint contracture, elbow

Post-traumatic syringomyelia and other causes of neurological changes

The major cause of neurological deterioration in SCI patients is post-traumatic syringomyelia (PTS), which is a disastrous complication leading to neurological and functional deterioration.

Conclusion

The aims of SCI management include ensuring neurological recovery, preventing avoidable complications and achieving maximum independence and moreover social integration. SCI is one of the most complex neurological diseases due to this multisystem impairment. SCI management must be conducted in highly specialized centers, by interdisciplinary and multidisciplinary teams coordinated by SCI medicine sub-specialist physiatrists. We must keep in mind that, if well managed at the initial phase of

Disclosure of interest

The author declares that she has no competing interest.

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