Spinal Cord Injury
Spinal cord injury (SCI) is a serious neurological condition characterized by loss of motor, sensory and autonomic function following traumatic or non-traumatic damage to the spinal cord. The most common causes are motor vehicle accidents, falls and sports injuries. Cervical level injuries can result in tetraplegia, while thoracic-lumbar injuries can result in paraplegia. The severity and prognosis of the injury are assessed using the ASIA scale.
最終更新: 2026-06-07
Definition and Pathophysiology
Spinal cord injury develops through axonal disruption, hemorrhagic necrosis and ischemic changes following mechanical damage to the cord. The primary injury caused by mechanical forces at the moment of trauma is irreversible. The secondary injury that develops over hours to days afterward involves processes such as vascular damage, edema, inflammation and oxidative stress; this phase is potentially treatable and is the target of neuroprotective approaches.
Clinical Picture by Level
The anatomical level of injury determines the clinical picture. Cervical injuries (C1-C8) carry a risk of tetraplegia and respiratory failure; some upper limb function may be preserved at the C5-C8 level. Thoracic injuries (T1-T12) result in paraplegia with normal upper limbs. Conus medullaris syndrome occurs at the L1-L2 level, and below this level cauda equina syndrome, a nerve root injury with a relatively better prognosis, is seen.
Completeness and Syndromes
Whether the injury is complete or incomplete is the most important factor determining recovery potential. In complete injury (ASIA A), there is no sensory or motor function in the lowest sacral segments (S4-S5). In incomplete injury (ASIA B-D), function is preserved in the sacral segments and recovery potential is higher. Incomplete syndromes include central cord syndrome (best prognosis), Brown-Séquard syndrome (good prognosis) and anterior cord syndrome (worst prognosis). In the acute phase, spinal shock with transient flaccid paralysis and loss of reflexes may be seen.
Symptoms
Principal findings are motor weakness or complete paralysis below the level of injury, dermatomal sensory loss and a sensory level. In C3-C5 injuries the phrenic nerve may be affected, leading to respiratory failure. Autonomic dysfunction is common: loss of bladder-bowel control, sexual dysfunction and postural hypotension. In injuries above the T6 level, autonomic dysreflexia—triggered by stimuli such as a full bladder or bowel and presenting with severe blood pressure elevation—is an emergency. Spasticity and neuropathic pain may develop in the chronic phase.
Diagnosis
Diagnosis is made by systematic emergency assessment in trauma patients, with spinal immobilization applied until cord injury is excluded. Neurological status is assessed in detail by ASIA examination: motor strength in 10 key muscle groups, sensation in 28 dermatomes and sacral function (anal sensation, voluntary contraction, bulbocavernosus reflex). Computed tomography (CT) shows bony injury, while magnetic resonance imaging (MRI) shows cord contusion, hemorrhage, edema and compression; MRI findings provide information about prognosis.
Treatment
In the acute phase, stabilization of airway, breathing and circulation, maintenance of mean arterial pressure (to support cord perfusion) and respiratory support are priorities. Surgical decompression and stabilization are performed in the presence of cord compression or instability; in incomplete injuries, early decompression (within 24 hours) may contribute to neurological recovery. The use of high-dose methylprednisolone is controversial and is not routinely recommended in current guidelines. In intensive care, prevention of deep vein thrombosis, pressure sores and infection, and bladder-bowel management are critical.
Rehabilitation and Prognosis
In the chronic phase, comprehensive rehabilitation is the most important treatment component and aims to maximize functional independence. A multidisciplinary team provides physical therapy, occupational therapy, bladder-bowel training, spasticity and neuropathic pain management, and psychological support. In incomplete injuries, gait training and robotic-assisted systems may be used. The fastest neurological recovery occurs in the first 6 months and may continue up to 18-24 months. Although the chance of recovery is low in complete injury, rehabilitation markedly improves functional independence and quality of life. Outcomes are individual and cannot be guaranteed.
参考文献
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1132-1153.
- Kirshblum SC, Burns SP, Biering-Sorensen F, et al. International standards for neurological classification of spinal cord injury (ISNCSCI). J Spinal Cord Med. 2011;34(6):535-546.
- Fehlings MG, Vaccaro A, Wilson JR, et al. Early versus delayed decompression for traumatic cervical spinal cord injury (STASCIS). PLoS One. 2012;7(2):e32037.
- Ahuja CS, Wilson JR, Nori S, et al. Traumatic spinal cord injury. Nat Rev Dis Primers. 2017;3:17018.
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