Complications After Traumatic Spinal Cord Injury

People are living longer after SCI, but associated disorders can hurt quality of life.

Written by Michael G. Fehlings, MD, PhD, FRCSC, FACS

With advancements in spinal cord injury (SCI) research, people are living longer, more active lives after traumatic neck and/or back injury. But, it may come at a cost: Complications may arise many years after the initial injury.

This article reviews the most common spinal cord injury-associated diseases and disorders. Some of these complications are local, which means they affect a specific site in the body. Others are systemic complications, meaning they may become chronic disorders with widespread impact throughout your body.

It’s important to note that not everyone with SCI has these complications. While some complications are quite common, you may endure SCI and never experience other associated disorders after your initial surgical treatment.

Spinal Cord Injury—Local Complications

About 3% of people with SCI develop syringomyelia, which occurs when a fluid-filled cyst, or syrinx, forms within the spinal cord. The cyst grows larger over time, causing spinal cord compression and progressive myelopathy that can occur years after the SCI.

Some people with syringomyelia experience no symptoms and require only periodic monitoring. On the other end of the spectrum, patients with significant symptoms may undergo a surgical decompression procedure. Learn about syringomyelia.

Neuropathic joint arthropathy (or Charcot joint arthropathy)
Like syringomyelia, which can arise years after the initial spinal injury, neuropathic spinal arthropathy (or Charcot joint arthropathy) is a delayed SCI complication.

Neuropathic joint arthropathy is the slow destruction of a joint (including those in the hips, knees, ankles, shoulders, elbows, and spine). This complication is often diagnosed as many as 15 years after the initial SCI. Patients may develop a deformity, have pain below the sensory level of injury, reduced neurological function, and/or audible clicking sounds with movement.

Several treatment options exist for this type of arthropathy, including conservative monitoring, bracing, medications, and spinal fusion surgery.

Spasticity is a disorder marked by long-term muscle contraction that causes stiff or rigid muscles. This can make all types of movement, such as walking or talking, difficult. It can also affect sleep.

Spasticity affects 65 to 78% of people who have chronic SCI (that is, they are more than 1 year post-injury).

Common spasticity treatments include physical therapy, muscle relaxants, intrathecal drug therapy, botulinum toxin injections, and surgery.

Spinal Cord Injury—Systemic Complications

Abnormally low blood pressure is a common SCI complication, particularly in people whose injury is in their cervical (neck) or thoracic (mid-back) spine. About 60% of people have symptomatic orthostatic hypotension, which causes dizziness, weakness, and a temporary loss of consciousness when going from sitting/lying down to standing.

Common treatment includes wearing compression stockings or abdominal binding, and medication therapy.

Autonomic dysreflexia
Autonomic dysreflexia is caused by a damaging event below the level of injury, such as bowel impaction, bladder distension, or pressure sores. This results in dysfunction of the autonomic nervous system, which then prevents proper communication between the body and brain above the injury level. The autonomic nervous system is somewhat self-regulating in that it’s at work without your conscious awareness. During autonomic dysreflexia, bodily functions, such as breathing, blood pressure, and heart rate become unregulated.

If you have autonomic dysreflexia, your doctor will administer drugs that help regulate heart rate and relax your blood vessels.

This disorder can occur shortly after the SCI or years later, so long-term preventive health, including bowel and bladder care, is essential.

Respiratory complications are the leading cause of death in patients with chronic SCI.

Cervical and thoracic SCIs can weaken the chest and abdominal muscles, resulting in respiratory infections. Typical infections include the common cold, bronchitis, and pneumonia.

Patients may also experience fluid around the lungs, and are at greater risk of sleep apnea (involuntary pauses in breathing) and respiratory failure.

Your doctor may prescribe antibiotics to help clear your chest of infection, but more significant respiratory issues may require life-long ventilator dependency.

Other systemic complications of traumatic spinal cord injury include:

Continued Care Is Key to Managing Complications After Spinal Cord Injury
If you’ve endured a traumatic spinal cord injury, your care will not end once you leave the hospital. The best way to manage any potential problems is to stay current on your medical care, which may continue years after your injury. Keeping regular appointments with your medical team will ensure any problems are detected early, which can help preserve a meaningful quality of life.

Suggested Additional Reading
A special issue of the Global Spine Journal set forth guidelines for the Management of Degenerative Myelopathy and Acute Spinal Cord Injury, which is summarized on SpineUniverse in Summary of the Clinical Practice Guidelines for the Management of Degenerative Cervical Myelopathy and Traumatic Spinal Cord Injury.

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