The early period following spinal cord injury results in a "shock-like" situation (termed spinal shock) wherein all neurological function below the level of the injury essentially stops. This includes loss of nerve supply to blood vessels and other supportive structure such as blood vessel dilatation and constriction. As a result, edema develops. There is a lack of blood return to the heart when the person is in the sitting position. This called orthostatic hypotension and can be a persistent problems in some patients after spinal cord injury.
Respiratory complications and infection predominate as post-SCI complications. When the injury involves the upper thorax, the normal breathing pattern is permanently altered. The diaphragm does most of the work in quiet breathing. The chest wall muscles (intercostals) are used primarily for deep breathing or coughing. The abdominal muscles also participate in coughing. When the intercostal and abdominal muscles are paralyzed, the entire load is taken by the diaphragm. This results in poor coughing and a high risk of pneumonia. Pneumonia is one of the most common complications of acute spinal cord injury. Preventive measures are very important to reduce the risk of pneumonia. These include: percussion and drainage using gravity to assist; assisted coughing (also termed "quad" coughing); abdominal binders (to increase the resistance against which the diaphragm works); and early mobilization (i.e.; getting the patient out of bed as soon as possible.
Joint and muscle contractures can occur rapidly following SCI and complicate rehabilitation later on. Early stabilization of the spine fracture allows for earlier mobilization and therefore fewer complications. The normal implications of immobility and bed rest are accelerated in SCI and must be prevented by mobilizing the patient as soon as possible. Each complication increases the hospital stay and often increases the rehab stay. Data on early aggressive rehabilitative management following acute SCI suggest a dramatic effect in our SCI population.
A loss of contractile functioning to the smooth muscle in the small and large intestines results in what is termed an ileus. The normal peristalsis or milking action of the bowel stops and frequently requires a variety of medical measures to re-establish reflexive bowel functioning. Occasionally, obstruction occurs in the acute phase, termed Ogilvie's Syndrome. This must be treated with decompression through naso-gastric and rectal tubes and rarely, through surgery. Upon resolution of this post traumatic ileus the institution of a daily bowel program improves bowel evacuation and reduces the chance for obstruction. Every day or every other day bowel programs are instituted as early as possible to encourage "automatic" bowel functioning through reflex mechanisms.
The bladder muscle (termed the "detruser") and external sphincter are similarly affected. Early drainage occurs with indwelling ("foley") catheter. When urine volumes are equal to or less than 400 cc per 4 hr., the patient is converted to an intermittent catheterization program (ICP). Control fluid intake is closely monitored, especially at night (due to remobilization of fluid from the legs) Early catheter removal reduces the risk of infection (UTI) and allows for better fluid regulation and restriction if necessary Early ICP reduces foley catheter related complications (erosion, stones, recurrent infections, colonization, resistant organisms).
