Abstract
Initially, it was defined by Bastian as a complete severance of the spinal cord, which leads to a complete loss of motor and sensory function below the level of the lesion, as well as permanent extinction of tendon reflexes and muscle tone although the reflex arc remains intact. Flaccid motor paralysis is observed immediately after the acute onset of complete spinal cord injury below the level of injury with no motor responses to external stimuli. Sherrington replaced Bastian’s use of the term “permanent” with a “temporary” extinction of the reflex below the level of the lesion. Spinal shock is pronounced only in primates, especially in humans, due to such a dominance of an inhibitory mechanism in the spinal cord. In general, the more severe the physiologic or anatomic transection of the spinal cord, the more profound the spinal shock. Spinal shock does not occur with slowly developing spinal cord diseases or injuries.
The pattern of natural course following a spinal cord injury distinguishes between sudden onset and slow changes in the spinal cord. In the next days and weeks, motor reactions to external stimuli gradually reappear systematically. The definition of spinal shock and the pattern of reflex recovery or evolution and muscle tone recovery remain issues of debate and controversy. This chapter describes the definition, pathophysiology, and clinical significance of spinal shock, which is not well established and has a lot of controversies.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Atkinson PP, Atkinson JLD. Spinal shock. Mayo Clin Proc. 1996;71:384–9.
Bach-y-Rita P, Illis LS. Spinal shock: possible role of receptor plasticity and non synaptic transmission. Paraplegia. 1993;31:82–7.
Barnes CD, Schadt JC. Release of function in the spinal cord. Prog Neurobiol. 1979;12:1–13.
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.
Bunge RP, Puckett WR, Becerra JL, et al. 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. In: Seil FJ, editor. Advances in neurology. New York: Raven Press Ltd; 1993.
Bywater M, Tornic J, Mehnert U, et al. Detrusor acontractility after acute spinal cord injury-myth or reality? J Urol. 2018;199:1565–70.
Calancie B, Broton JG, Klose KJ, et al. Evidence that alterations in presynaptic inhibition contribute to segmental hypo-and hyperexcitability after spinal cord injury in man. Electroencephalogr Clin Neurophysiol. 1993;89:177–86.
Calancie B, Molano MR, Broton JG. Tendon reflexes for predicting movement recovery after acute spinal cord injury in humans. Clin Neurophysiol. 2004;115:2350–63.
Christensen PB, Wermuth L, Hinge HH, et al. Clinical course and long-term prognosis of acute transverse myelopathy. Acta Neurol Scand. 1990;81:431–5.
Dimitrijević MR, Nathan PW. Studies of spasticity in man: 3. Analysis of reflex activity evoked by noxious cutaneous stimulation. Brain. 1968;91:349–68.
Ditunno JF, Little JW, Tessler A, et al. Spinal shock revisited: a four-phase model. Spinal Cord. 2004;42:383–95.
Eckert MJ, Martin MJ. Trauma: spinal cord injury. Surg Clin North Am. 2017;97:1031–45.
Fam B, Yalla SV. Vesicourethral dysfunction in spinal cord injury and its management. Semin Neurol. 1988;8:150–5.
Guillain G, Barre JA. Etude anatomo-clinique de quinze cas de section totalle de la moelle. Ann Méd. 1917;2:178–222.
Guttmann L. Studies on reflex activity of the isolated cord in spinal man. J Nerv Ment Dis. 1952;116:957–72.
Guttmann L. Spinal shock and reflex behaviour in man. Paraplegia. 1970;8:100–16.
Guttmann L. Spinal cord injuries: comprehensive management and research. 2nd ed. Oxford: Blackwell Scientific Publications; 1976.
Hall M. Second memoir on some principles of the pathology of the nervous system. Med Chir Trans. 1840;23:121–67.
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. London: H. Baillière; 1841.
Hiersemenzel LP, Curt A, Dietz V. From spinal shock to spasticity: neuronal adaptations to a spinal cord injury. Neurology. 2000;54:1574–82.
Holdsworth FW. Neurological diagnosis and the indications for treatment of paraplegia and tetraplegia, associated with fractures of the spine. Manit Med Rev. 1968;48:16–8.
Illis LS. The motor neuron surface and spinal shock. Mod Trends Neurol. 1967;4:53–68.
Ko HY, Ditunno JF, Graziani V, et al. The pattern of reflex recovery during spinal shock. Spinal Cord. 1999;37:402–9.
Kuhn RA. Functional capacity of the isolated human spinal cord. Brain. 1950;73:1–51.
Landau WM, Clare MH. The plantar reflex in man, with special reference to some conditions where the extensor response is unexpectedly absent. Brain. 1959;82:321–55.
Leis AA, Kronenberg MF, Stĕtkárová I, et al. Spinal motoneuron excitability after acute spinal cord injury in humans. Neurology. 1996;47:231–7.
Levi L, Wolf A, Belzberg H. Hemodynamic parameters in patients with acute cervical cord trauma: description, intervention, and prediction of outcome. Neurosurgery. 1993;33:1007–16.
Lloyd LK. New trends in urologic management of spinal cord injured patients. Cent Nerv Syst Trauma. 1986;3:3–12.
McCouch GP, Austin GM, Liu CN, et al. Sprouting as a cause of spasticity. J Neurophysiol. 1958;21:205–16.
Mendell LM. Physiological aspects of synaptic plasticity: the Ia/motoneuron connection as a model. Adv Neurol. 1988;47:337–60.
Nacimiento W, Noth J. What, if anything, is spinal shock? Arch Neurol. 1999;56:1033–5.
Petersen JA, Schubert M, Dietz V. The occurrence of the Babinski sign in complete spinal cord injury. J Neurol. 2010;257:38–43.
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.
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-Legacy Content. 1935;114:457–67.
Schadt JC, Barnes CD. Motoneuron membrane changes associated with spinal shock and the Schiff-Sherrington phenomenon. Brain Res. 1980;201:373–283.
Schwarz GM, Hirtler L. The cremasteric reflex and its muscle – a paragon of ongoing scientific discussion: a systematic review. Clin Anat. 2017;30:498–507.
Sherrington C. The integrative action of the nervous system. London: Constable & Company LTD.; 1906.
Silver JR. Spinal shock revisited: a four-phase model. Comment on spinal shock revisited: a four-phase model. Spinal Cord. 2005;43:450.
Simpson RK Jr, Robertson CS, Goodman JC. Glycine: an important potential component of spinal shock. Neurochem Res. 1993;18:887–92.
Simpson RK Jr, Robertson CS, Goodman JC. The role of glycine in spinal shock. J Spinal Cord Med. 1996;19:215–24.
Stauffer ES. Diagnosis and prognosis of acute cervical spinal cord injury. Clin Orthop Relat Res. 1975;112:9–15.
Sullivan MP, Yalla SV. Detrusor contractility and compliance characteristics in adult male patients with obstructive and nonobstructive voiding dysfunction. J Urol. 1996;155:1995–2000.
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;372:343–55.
Tulloch AG, Rossier AB. The autonomic nervous system and the bladder during spinal shock—an experimental study. Paraplegia. 1975;13:42–8.
Van Gijn J. The Babinski sign and the pyramidal syndrome. J Neurol Neurosurg Psychiatry. 1978;41:865–73.
van Gijn J. The Babinski sign: the first hundred years. J Neurol. 1996;243:675–83.
van Harreveld A. On spinal shock. Proc Natl Acad Sci U S A. 1940;26:65–7.
van Munster CE, Weinstein HC, Uitdehaag BM, et al. 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;259:2424–8.
Weaver RA, Landay WM, Higgins JF. Fusimotor function: part II. Evidence of fusimotor depression in human spinal shock. Arch Neurol. 1963;9:127–32.
Weinstein DE, Ko HY, Graziani V, et al. Prognostic significance of the delayed plantar reflex following spinal cord injury. J Spinal Cord Med. 1997;20:207–11.
White RJ, Likavec MJ. Spinal shock-spinal man. J Trauma. 1999;56:979–80.
Wolpaw JR, Tennissen AM. Activity-dependent spinal cord plasticity in health and disease. Annu Rev Neurosci. 2001;24:807–43.
Recommended Additional Reading
Campbell WW, editor. DeJong’s the neurologic examination. 7th ed. New York: Wolters Kluwer Lippincott Williams & Wilkins; 1992.
Fehlings MG, Vccaro AR, Roakye M, et al., editors. Essentials of spinal cord injury: basic research to clinical practice. New York: Thieme; 2013.
Fulton JF, Keller AD. The sign of Babinski: a study of the evolution of cortical dominance in primates. Springfield: Charles C Thomas; 1932.
Guttmann L. Spinal cord injuries. Comprehensive management and research. Oxford: Blackwell Scientific Publications; 1976.
Harrison P. Managing spinal injury: critical care. The international management of people with actual or suspected spinal cord injury in high dependency and intensive care unit. London: The Spinal Injury Association; 2000.
Illis LS, editor. Spinal cord dysfunction: assessment. Oxford: Oxford University Press; 1988.
Jallo J, Vaccaro AR, editors. Neurotrauma and critical care of the spine. 2nd ed. New York: Thieme; 2018.
Vanderah T, Gould DJ. Nolte’s the human brain. Philadelphia: Elsevier; 2016.
Verhaagen J, McDonald JW III. Spinal cord injury. In: Aminoff MJ, Boller F, Swaab DF, editors. Handbook of clinical neurology, vol. 109. 3rd series ed. London: Elsevier; 2012.
Weaver LC, Polosa C, editors. Autonomic dysfunction after spinal cord injury. In: progress in brain research, vol. 152. New York: Elsevier; 2006.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Ko, HY. (2022). Spinal Shock: Definition and Reflex Evolution Pattern. In: Management and Rehabilitation of Spinal Cord Injuries. Springer, Singapore. https://doi.org/10.1007/978-981-19-0228-4_14
Download citation
DOI: https://doi.org/10.1007/978-981-19-0228-4_14
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-19-0227-7
Online ISBN: 978-981-19-0228-4
eBook Packages: MedicineMedicine (R0)