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World J Orthop. Jan 18, 2015; 6(1): 17-23
Published online Jan 18, 2015. doi: 10.5312/wjo.v6.i1.17
Acute complications of spinal cord injuries
Ellen Merete Hagen
Ellen Merete Hagen, Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Regional Hospital of Viborg, 8800 Viborg, Denmark
Ellen Merete Hagen, Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
Ellen Merete Hagen, Institute of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
Author contributions: Hagen EM solely contributed to this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Ellen Merete Hagen, Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Regional Hospital of Viborg, Heibergs Alle 4, 8800 Viborg, Denmark. e-mhagen@online.no
Telephone: +45-78-446177 Fax: +45-78-446159
Received: October 24, 2013
Peer-review started: October 25, 2013
First decision: November 12, 2013
Revised: December 24, 2013
Accepted: May 28, 2014
Article in press: May 29, 2014
Published online: January 18, 2015
Processing time: 453 Days and 3.2 Hours
Abstract

The aim of this paper is to give an overview of acute complications of spinal cord injury (SCI). Along with motor and sensory deficits, instabilities of the cardiovascular, thermoregulatory and broncho-pulmonary system are common after a SCI. Disturbances of the urinary and gastrointestinal systems are typical as well as sexual dysfunction. Frequent complications of cervical and high thoracic SCI are neurogenic shock, bradyarrhythmias, hypotension, ectopic beats, abnormal temperature control and disturbance of sweating, vasodilatation and autonomic dysreflexia. Autonomic dysreflexia is an abrupt, uncontrolled sympathetic response, elicited by stimuli below the level of injury. The symptoms may be mild like skin rash or slight headache, but can cause severe hypertension, cerebral haemorrhage and death. All personnel caring for the patient should be able to recognize the symptoms and be able to intervene promptly. Disturbance of respiratory function are frequent in tetraplegia and a primary cause of both short and long-term morbidity and mortality is pulmonary complications. Due to physical inactivity and altered haemostasis, patients with SCI have a higher risk of venous thromboembolism and pressure ulcers. Spasticity and pain are frequent complications which need to be addressed. The psychological stress associated with SCI may lead to anxiety and depression. Knowledge of possible complications during the acute phase is important because they may be life threatening and/ or may lead to prolonged rehabilitation.

Keywords: Spinal cord injuries; Autonomic dysreflexia; Cardiovascular disease; Orthostatic hypotension; Bradycardia; Thromboembolism; Respiratory insufficiency

Core tip: The paper provides an overview of acute complications of spinal cord injury. Frequent complications in the acute phase of are bradyarrhythmias and hypotension. Other complications are instability of temperature (hypothermia and hyperthermia), pain, spasticity and autonomic dysreflexia (AD). AD is associated with an abrupt, uncontrolled sympathetic response, elicited by stimuli below the level of injury, and it can cause severe hypertension, cerebral haemorrhage and death. All personnel caring for the patient should be able to recognize the symptoms and intervene promptly. Knowledge of possible complications during the acute phase is important because they may be life-threatening and/or may lead to prolonged rehabilitation.