Measures May Prevent Common Complications of Spinal Cord Injury

Michael G. Fehlings, MD, PhD, comments

Peer Reviewed

The most common complications of spinal cord injury are pulmonary (respiratory failure, pneumonia), cardiovascular (hypotension, bradycardia, autonomic dysreflexia), and infectious causes (pneumonia, urinary tract infections), according to a literature review by Rochelle Sweis, DO, and José Biller, MD, of Loyola Medicine. The review was published in the February issue of Current Neurology and Neuroscience Reports.

Patients with spinal cord injury also are at higher risk for bladder, bowel and sexual dysfunction; constipation and other gastrointestinal problems; pressure ulcers; and chronic pain, the researchers found.

blood pressure instrumentsResearchers highlighted that following early measures may prevent acute complications of spinal cord injury.Early Measures May Prevent Complications
The researchers highlighted the following early measures that may prevent acute complications of spinal cord injury: maintaining adequate mean arterial pressure goals (85–90 mmHg for 5 to 7 days) and treating autonomic dysreflexia, neurogenic, and spinal shock.

Other preventative measures noted by the researchers include early range of motion and rehabilitation, splinting and using orthoses, initiation of a bowel regimen and bladder program, clearance of pulmonary secretions, mechanical ventilator support, optimization of nutrition, and prevention of pressure ulcers.

“The first step in preventing or managing complications, is an awareness of what complications can occur, commented Michael G. Fehlings, MD, PhD who is Professor of Neurosurgery and Co-Director of the Spine Program at the University of Toronto in Ontario. “Spinal cord injury—whether from traumatic or nontraumatic causes—can affect almost all the body systems.”

“Some of these complications are preventable, and the impact of other potentially life-threatening complications can be less severe if they are recognized early,” Dr. Fehlings told SpineUniverse.

Complications that may be preventable include pressure sores, with interventions such as frequent turning of the patient and padding of surfaces being recommended, Dr. Fehlings said. “In addition, while thromboembolic complications may not be entirely preventable, the incidence of these complications may be dramatically lowered using thrombotic prophylaxis treatments,” Dr. Fehlings said.

Autonomic dysreflexia is an example of a life-threatening complication that is not as easily preventable, Dr. Fehlings said. In this condition, the bladder or bowel becomes distended and can result in a life-threatening hypertensive crisis that may lead to intra-cerebral bleed if not recognized and treated early, Dr. Fehlings explained. Thus, if a patient experiences a hypertensive spike, it is important to check if the patient’s bladder or bowel is distended.

“Putting a catheter in the bladder and releasing the urine might treat the hypertension,” Dr Fehlings said.

Managing Patient Expectations
Among patients with incomplete paraplegia, 80% are expected to stand by 12 months, and 50% are ambulatory by 12 months, with improvements continuing for 2 years after injury, the researchers reported.

Outcomes are highly dependent on the level of injury and patient age. For example, life expectancy ranges from 1.5 years for patients who are ventilator-dependent and older patients (>60 years regardless of level of injury) to 52.6 years for younger patients (age 20) with preserved motor function.

“With high spinal cord injury, which is often the most debilitating, these complications unfortunately are often expected early on in their hospital course and may or may not persist depending on the level of care, patient, and other systemic complications,” said Dr. Sweis, who is Assistant Professor of Neurology at Loyola University Chicago Stritch School of Medicine in Maywood, IL.

Stem Cell Research Shows Promise
“Recovery remains promising given recent results of stem cell implantation for high spinal cord injury patients, with studies showing return of some motor function,” Dr. Sweis said. The authors also note that gene therapy and electrical stimulation are also promising therapies under investigation, adding that continued research on all of these treatments is a must to change patients’ lives. 

Updated on: 03/20/18
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Michael G. Fehlings, MD, PhD, FRCSC, FACS
Professor of Neurosurgery
University of Toronto
Toronto, ON
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