Korean J Neurotrauma.  2018 Oct;14(2):47-54. 10.13004/kjnt.2018.14.2.47.

Revisit Spinal Shock: Pattern of Reflex Evolution during Spinal Shock

• Ko HY

• KMID: 2424312
• DOI: http://doi.org/10.13004/kjnt.2018.14.2.47

Abstract

When the spinal cord is suddenly severed, all the fundamental functions of the spinal cord below the level of injury including the spinal cord reflexes are immediately depressed, which is referred to as spinal shock. The resolution of spinal shock occurs over a period of days to months, and spinal shock slowly transitions to spasticity. The definition of spinal shock and the pattern of reflex recovery or evolution remains as an issue of debate and controversy. The identification of clinical signs that determine the duration of spinal shock is controversial. The underlying mechanisms of spinal shock are also not clearly defined. Various authors have defined the termination of spinal shock as the appearance of the bulbocavernosus reflex, the recovery of deep tendon reflexes, or the return of reflexic detrusor activity. However, many questions remain to be answered, such as: When should we define spinal shock as the end? What types of reflexes appear first among polysynaptic cutaneous reflexes, monosynaptic deep tendon reflexes, and pathological reflexes? Should it include changes in autonomic reflexes such as a detrusor reflex?

Keyword

Automatism; Reflex; Spinal cord; Spinal cord injuries

MeSH Terms

Automatism
Muscle Spasticity
Reflex*
Reflex, Stretch
Shock*
Spinal Cord
Spinal Cord Injuries

Reference

1. Ashby P, Verrier M, Lightfoot E. Segmental reflex pathways in spinal shock and spinal spasticity in man. J Neurol Neurosurg Psychiatry. 1974; 37:1352–1360. PMID: 4375172.

2. Atkinson PP, Atkinson JL. Spinal shock. Mayo Clin Proc. 1996; 71:384–389. PMID: 8637263.

3. Bach-y-Rita P, Illis LS. Spinal shock: possible role of receptor plasticity and non synaptic transmission. Paraplegia. 1993; 31:82–87. PMID: 8383312.

4. Barnes CD, Schadt JC. Release of function in the spinal cord. Prog Neurobiol. 1979; 12:1–13. PMID: 394187.

5. Bastian HC. On the symptomatology of total transverse lesions of the spinal cord; with special reference to the condition of the various reflexes. Med Chir Trans. 1890; 73:151–217.

6. Bunge RP, Puckett WR, Becerra JL, Marcillo A, Quencer RM. Observations on the pathology of human spinal cord injury. A review and classification of 22 new cases with details from a case of chronic cord compression with extensive focal demyelination. Adv Neurol. 1993; 59:75–89. PMID: 8420126.

7. Burke RE. Sir Charles Sherrington's the integrative action of the nervous system: a centenary appreciation. Brain. 2007; 130:887–894. PMID: 17438014.

8. Calancie B, Broton JG, Klose KJ, Traad M, Difini J, Ayyar DR. Evidence that alterations in presynaptic inhibition contribute to segmental hypo- and hyperexcitability after spinal cord injury in man. Electroencephalogr Clin Neurophysiol. 1993; 89:177–186. PMID: 7686850.

9. Calancie B, Molano MR, Broton JG. Tendon reflexes for predicting movement recovery after acute spinal cord injury in humans. Clin Neurophysiol. 2004; 115:2350–2363. PMID: 15351378.

10. Christensen PB, Wermuth L, Hinge HH, Bømers K. Clinical course and long-term prognosis of acute transverse myelopathy. Acta Neurol Scand. 1990; 81:431–435. PMID: 2375246.

11. Dimitrijević MR, Nathan PW. Studies of spasticity in man. 3. Analysis of revlex activity evoked by noxious cutaneous stimulation. Brain. 1968; 91:349–368. PMID: 5721935.

12. Ditunno JF, Little JW, Tessler A, Burns AS. Spinal shock revisited: a four-phase model. Spinal Cord. 2004; 42:383–395. PMID: 15037862.

13. Guillain G, Barré JA. Étude anatomo-clinique de quinze cas de section totale de la moelle. Ann Med. 1917; 2:178–222.

14. Guttmann L. Studies on reflex activity of the isolated cord in the spinal man. J Nerv Ment Dis. 1952; 116:957–972. PMID: 13045163.

15. Guttmann L. Spinal shock and reflex behaviour in man. Paraplegia. 1970; 8:100–116. PMID: 5505741.

16. Guttmann L. Spinal cord injuries: Comprehensive management and research. ed 2. Oxford, UK: Blackwell Scientific;1976.

17. Hall M. Second Memoir on some principles of the pathology of the nervous system. Med Chir Trans. 1840; 23:121–167.

18. Hall M. On the diseases and derangements of the nervous system, in their primary forms and in their modifications by age, sex, constitution, hereditary predisposition, excesses, general disorder, and organic disease. ed 1841/10/01. London, UK: Baillière;1841. p. 305–337.

19. Hiersemenzel LP, Curt A, Dietz V. From spinal shock to spasticity: neuronal adaptations to a spinal cord injury. Neurology. 2000; 54:1574–1582. PMID: 10762496.

20. Holdsworth FW. Neurological diagnosis and the indications for treatment of paraplegia and tetraplegia, associated with fractures of the spine. Manit Med Rev. 1968; 48:16–18. PMID: 5636634.

21. Illis LS. The motor neuron surface and spinal shock. Mod Trends Neurol. 1967; 4:53–68. PMID: 4369327.

22. Ko HY, Ditunno JF Jr, Graziani V, Little JW. The pattern of reflex recovery during spinal shock. Spinal Cord. 1999; 37:402–409. PMID: 10432259.

23. Landau WM, Clare MH. The plantar reflex in man, with special reference to some conditions where the extensor response is unexpectedly absent. Brain. 1959; 82:321–355. PMID: 14413775.

24. Leis AA, Kronenberg MF, Stĕtkárová I, Paske WC, Stokić DS. Spinal motoneuron excitability after acute spinal cord injury in humans. Neurology. 1996; 47:231–237. PMID: 8710084.

25. Levi L, Wolf A, Belzberg H. Hemodynamic parameters in patients with acute cervical cord trauma: description, intervention, and prediction of outcome. Neurosurgery. 1993; 33:1007–1016. PMID: 8133985.

26. Little JW. Serial recording of reflexes after feline spinal cord transection. Exp Neurol. 1986; 93:510–521. PMID: 3743697.

27. McCouch GP, Austin GM, Liu CN, Liu CY. Sprouting as a cause of spasticity. J Neurophysiol. 1958; 21:205–216. PMID: 13539657.

28. Mendell LM. Physiological aspects of synaptic plasticity: the Ia/motoneuron connection as a model. Adv Neurol. 1988; 47:337–360. PMID: 3278522.

29. Nacimiento W, Noth J. What, if anything, is spinal shock? Arch Neurol. 1999; 56:1033–1035. PMID: 10448814.

30. Petersen JA, Schubert M, Dietz V. The occurrence of the Babinski sign in complete spinal cord injury. J Neurol. 2010; 257:38–43. PMID: 19705053.

31. Riddoch G. The reflex functions of the completely divided spinal cord in man, compared with those associated with less severe lesions. Brain. 1917; 40:264–402.

32. Ruch TC. Evidence of the non-segmental character of spinal reflexes from an analysis of the cephalad effects of spinal transection (Schiff-sherrington phenomenon). Am J Physiol. 1935; 114:457–467.

33. Schadt JC, Barnes CD. Motoneuron membrane changes associated with spinal shock and the Schiff-Sherrington phenomenon. Brain Res. 1980; 201:373–383. PMID: 7417848.

34. Sherrington CS. The integrative action of the nervous system. London, UK: New Haven Yale University Press;1920.

35. Silver JR. Early autonomic dysreflexia. Spinal Cord. 2000; 38:229–233. PMID: 10822393.

36. Silver JR. Spinal shock revisited: a four-phase model. Spinal Cord. 2005; 43:450. PMID: 15724145.

37. Simpson RK Jr, Robertson CS, Goodman JC. Glycine: an important potential component of spinal shock. Neurochem Res. 1993; 18:887–892. PMID: 8103919.

38. Simpson RK Jr, Robertson CS, Goodman JC. The role of glycine in spinal shock. J Spinal Cord Med. 1996; 19:215–224. PMID: 9237788.

39. Stauffer ES. Diagnosis and prognosis of acute cervical spinal cord injury. Clin Orthop Relat Res. 1975; 9–15.

40. Tai Q, Goshgarian HG. Ultrastructural quantitative analysis of glutamatergic and GABAergic synaptic terminals in the phrenic nucleus after spinal cord injury. J Comp Neurol. 1996; 372:343–355. PMID: 8873865.

41. Van Gijn J. The Babinski sign and the pyramidal syndrome. J Neurol Neurosurg Psychiatry. 1978; 41:865–873. PMID: 310447.

42. van Gijn J. The Babinski sign: the first hundred years. J Neurol. 1996; 243:675–683. PMID: 8923299.

43. van Harreveld A. On spinal shock. Proc Natl Acad Sci U S A. 1940; 26:65–67. PMID: 16577966.

44. van Munster CE, Weinstein HC, Uitdehaag BM, van Gijn J. The plantar reflex: additional value of stroking the lateral border of the foot to provoke an upgoing toe sign and the influence of experience. J Neurol. 2012; 259:2424–2428. PMID: 22544298.

45. Weaver RA, Landau WM, Higgins JF. Fusimotor function. II. Evidence of fusimotor depression in human spinal shock. Arch Neurol. 1963; 9:127–132. PMID: 14048160.

46. Weinstein DE, Ko HY, Graziani V, Ditunno JF Jr. Prognostic significance of the delayed plantar reflex following spinal cord injury. J Spinal Cord Med. 1997; 20:207–211. PMID: 9144610.

47. White RJ, Likavec MJ. Spinal shock-spinal man. J Trauma. 1999; 46:979–980. PMID: 10338431.

48. Wolpaw JR, Tennissen AM. Activity-dependent spinal cord plasticity in health and disease. Annu Rev Neurosci. 2001; 24:807–843. PMID: 11520919.