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:

• Physiological consequences of spinal cord transection
• Management of acute high spinal injury
• Important spinal cord injury syndromes

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.