List the likely complications of cervical Spinal Cord Injury.

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College Answer

The likely complications are multiple. One approach is to divide them according to acute
respiratory, acute cardiovascular, other acute issues, and subacute/chronic complications:

Acute Respiratory complications
•    Respiratory failure: Lesions above C3 result in respiratory arrest; Lesions above C5 can still result in respiratory failure; Increased likelihood with VC < 15ml/kg, work of breathing, hypoxia, coexisting head or other injuries
•    Poor cough with difficulty with clearance of secretions
•    Atelectasis
•    Pulmonary oedema due to cardiac failure, over vigorous fluid management ARDS (numerous causes) or neurogenic pulmonary oedema

Acute Cardiovascular complications
•    Sympathetic denervation of the heart (with bradycardia, decreased inotropy) and peripheral vasculature (vasodilation)
•    Hypotension from above causes
•    Tendency to cardiac failure with overvigorous fluid management, especially if cardiac sympathetics lost

Other Acute issues
•    Deep Vein Thrombosis & Pulmonary embolism (4- 10% without prophylaxis)
•    Bowel denervation – paralytic ileus and gastroparesis
•    Bladder denervation – urinary retention with increased risk of urinary tract infection
•    Abnormal temperature regulation

Subacute and Chronic issues
•    Pressure areas – loss of mobility and sensation
•    Risk of sepsis – Pulmonary, UTI, Pressure areas and occult peritoneal infection
•    Autonomic hyperreflexia – 70 – 90% patients with lesion above T7
•    Hyperkalaemia with suxamethonium – especially after 24 hours
•    Psychological

Discussion

The early and late complications of spinal cord injury are discussed in greater detail in chapters dedicated to that topic:

The Physiological Consequences of Spinal Cord Injury

Respiratory consequences

  • Decreased maximum tidal volume
  • Rapid respiratory fatigue
  • Vital capacity increases in the supine position

Cardiovascular consequences

  • Decreased peripheral vascular resistance
  • Decreased preload
  • Increased α-adrenoceptor responsiveness
  • Autonomic dysreflexia
  • Loss of postural homeostatic reflexes
  • Bradycardia.
  • Fixed cardiac output

Metabolic and endocrine consequences

  • Inappropriate antiduiretic hormone secretion (SIADH)
  • Hyperaldosteronism
  • Insulin resistance
  • Suxamethonium sensitivity
  • Hypercalcemia, osteoporosis and renal calculi
  • Hypothermia of spinal cord injury

Gastrointestinal consequences of spinal injury

  • Decreased gastric transit, and acute gastric dilatation
  • Paralytic ileus
  • The "body cast syndrome"
  • Stress ulceration following spinal cord injury

Of the college answer, the issues which this table does not touch upon are those which are generic to immobility, and therefore boring. We are of course talking about pressure areas, DVTs, psychological morbidity, et cetera.

References

Baydur, Ahmet, Rodney H. Adkins, and Joseph Milic-Emili. "Lung mechanics in individuals with spinal cord injury: effects of injury level and posture." Journal of applied Physiology 90.2 (2001): 405-411.

 

Teasell, Robert W., et al. "Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury." Archives of physical medicine and rehabilitation 81.4 (2000): 506-516.