Orthopaedic MD

Spinal cord injury (SCI) can result in clinically significant compromise of cardiovascular control with associated short- and long-term consequences.1, 2 Impaired control of the autonomic nervous system (ANS), especially in individuals with high thoracic and cervical SCI, can result in various problems, such as hypotension, bradycardia, and autonomic dysreflexia.3, 4 Additional associated cardiovascular concerns in SCI, such as deep venous thrombosis (DVT) and long-term risk for coronary heart disease (CHD), also are briefly discussed in this article.
Synonyms and related keywords: cardiovascular concerns in spinal cord injury, neurogenic shock, orthostatic hypotension, spinal cord injury, SCI, autonomic nervous system, ANS, autonomic dysreflexia, deep vein thrombosis, DVT, coronary heart disease, CHD, bradycardia
McKinley, Garstang & Danesh 2008

The objectives of rehabilitation after an individual has sustained an acute spinal cord injury (SCI) include maximizing an individual's medical, functional, and psychosocial outcomes and providing education to the patient and his/her family. Rehabilitation should begin as soon as possible after injury in order to optimize outcomes and reduce complications.
Synonyms and related keywords: prognosis after spinal cord injury, functional outcomes after SCI, SCI, spinal cord injury motor prognosis, functional gains after SCI, neuroprosthesis, central cord syndrome, Brown-Séquard syndrome, anterior cord syndrome, posterior cord syndrome, conus medullaris syndrome, cauda equina syndrome, American Spinal Injury Association Impairment Scale, ASIA Impairment Scale, tetraplegia
McKinley et al 2008

Heterotopic ossification (HO) following spinal cord injury (SCI) was described first by Dejerine and Ceillier in 1918 as paraosteoarthropathy. The process is one of formation of mature lamellar bone, which is indistinguishable from normal bone, in soft tissues surrounding paralyzed joints. The bone is not connected to periosteum and becomes encapsulated as it matures. The pathology is similar to that of fracture callus, except that bone forms in the connective tissue between the muscle planes. HO also is seen after other neurologic insults such as traumatic brain injury (TBI) and stroke, as well as after thermal injuries and orthopedic procedures (eg, total hip replacement). In experimental models of HO formation, ischemia and tissue expression of bone morphogenic proteins have been shown to play important roles. Bone morphogenic proteins likely act on mesenchymal stem cells present in tissue and, thus, activate them to differentiate into osteoblasts (Banovac, 2004).

The immobilization from acute spinal cord injury (SCI) stimulates osteoclastic bone resorption. This process results in calcium loss from the bones and hypercalciuria. Hypercalcemia results when the efflux of calcium is massive or the glomerular filtration rate of the kidneys is reduced. The onset of hypercalcemia usually is insidious. The patient may present with vague and varied symptoms beginning several weeks after SCI. Clinicians should suspect hypercalcemia in high-risk groups. If untreated, patients may develop dehydration, personality changes, calcium oxalate nephrolithiasis, and renal failure. Treatment is aimed at early mobilization, hydration, and restoration of the balance between calcium excretion and resorption.
Synonyms and related keywords: hypercalcemia, spinal cord injury , SPI, osteoclastic bone resorption, immobilization hypercalcemia, calcium loss, hypercalciuria, calcium oxalate nephrolithiasis, renal failure, parathyroid hormone, natriuresis, nephrogenic diabetes insipidus, polyuria, extracellular fluid contraction, polydipsia, urinary stones, nephrocalcinosis, immobilization after spinal cord injury
Teresa L Massagli, MD 2006

One of the inevitable complications of spinal cord injury (SCI) is the associated osteoporosis that occurs predominantly in the pelvis and the lower extremities. The acute treatment of patients with SCI has always focused on the injury itself and on the immediate complications that subsequently arise. Bone loss as a consequence of SCI has been of secondary concern historically. Osteoporosis in persons with SCI was first studied in relation to calcium metabolism and the associated hypercalcemia and renal calculi that followed. The differences between SCI-induced osteoporosis and other causes of bone loss (disuse), such as prolonged bed rest, space travel, and lower motor neuron disorders, have since become clearer. New technologies allow monitoring of osteoblastic and osteoclastic activity at the microscopic level, while modern radiographic techniques have allowed more refined studies to be undertaken at the macroscopic level.
Synonyms and related keywords: spinal cord injury, osteoporosis, osteoporosis and SCI, SCI-induced osteoporosis, functional electrical stimulation, FES, dual-energy radiographic absorptiometry scan, dual-energy X-ray absorptiometry scan, DRA, DXA
David Weiss, MD 2008

First described by Bastian in 1867, posttraumatic syringomyelia (PTS) refers to the development and progression of a cyst filled with cerebrospinal fluid (CSF) within the spinal cord. PTS is a relatively infrequent, but potentially devastating, complication following traumatic spinal cord injury (SCI). PTS is characterized clinically by the often insidious progression of pain and loss of sensorimotor function that may manifest many years after traumatic SCI. If left untreated, PTS can result in loss of function, chronic pain, respiratory failure, or death.
Synonyms and related keywords: syringomyelia, posttraumatic cystic myelopathy, progressive posttraumatic cystic myelopathy, progressive posttraumatic noncystic myelopathy, cystic myelopathy, syrinx, posttraumatic spinal cord injury, syringomyelia, late neurological deterioration following spinal cord injury
Goetze & Priebe 2007

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are common complications of acute spinal cord injury (SCI) and a major cause of morbidity and mortality in this patient population. Many patients with SCI do not receive DVT prophylaxis in the acute care setting, perhaps secondary to concomitant medical problems that may enhance the risk of bleeding. In a recent retrospective study by Powell et al, 38.6% of patients admitted to a rehabilitation hospital were receiving prophylaxis. Clinically apparent DVT occurs in approximately 15% of patients with acute SCI, and PE develops in approximately 5% of these patients. The risk of DVT is highest in the first 2 weeks following injury, with peak occurrence between days 7 and 10. DVT has been detected as early as 72 hours postinjury; however, risk prior to this time appears to be low.
Synonyms and related keywords: deep venous thrombosis, pulmonary embolism, thromboembolic disease
McKinney & Garstang 2006

Patients with spinal cord injury (SCI) usually have permanent and often devastating neurologic deficits and disability.
The goals for the emergency physician are to establish the diagnosis and initiate treatment to prevent further neurologic injury from either pathologic motion of the injured vertebrae or secondary injury from the deleterious effects of cardiovascular instability or respiratory insufficiency.
Synonyms and related keywords: spinal cord injury, SCI, anterior cord syndrome, Brown-Séquard syndrome, central cord syndrome, conus medullaris syndrome, cauda equina syndrome, incomplete SCI syndromes, spinal cord concussion, spinal cord injury syndromes, SCIWORA, spinal cord injury without radiologic abnormality
Donald Schreiber, MD

The characteristics of aging have been well defined through the years. Menter and Hudson describe normal aging as involving 3 processes, all overlapping and distinctly different. These processes include (1) the physiologic changes of the body itself, (2) the individual's changing social roles, and (3) self-realization. This article focuses primarily on the physiological changes in aging.
Synonyms and related keywords: spinal cord injury, SCI and aging, osteoporosis
Terry Winkler, MD 2007

Spinal cord injury (SCI) is an insult to the spinal cord resulting in a change, either temporary or permanent, in its normal motor, sensory, or autonomic function. The International Standards for Neurological and Functional Classification of Spinal Cord Injury is a widely accepted system describing the level and the extent of injury based on a systematic motor and sensory examination of neurologic function.
Synonyms and related keywords: Brown-Séquard syndrome, central cord syndrome, anterior cord syndrome, conus medullaris syndrome, cauda equina syndrome
Segun T Dawodu, MD 2007

Spinal cord disease can result from diverse pathologic processes including trauma. Irrespective of the pathogenesis, it can lead to significant impairment of motor, sensory, or autonomic function. This review focuses on the clinical description of common patterns of spinal cord involvement. Considerable differences exist in terms of clinical complications after traumatic and nontraumatic spinal cord injury (SCI). In this article, the general principles of management of traumatic SCI are emphasized.
Synonyms and related keywords: spinal cord disease, spinal cord injury, SCI, complete spinal cord transection syndrome, anterior cord syndrome, central cord syndrome, Brown-Séquard syndrome, cauda equina syndrome, conus medullaris syndrome, Horner syndrome, traumatic spinal cord injury, nontraumatic spinal cord injury, direct compression, ischemia
Francisco de Assis Aquino Gondim, MD, MSc, PhD, & Florian P Thomas, MD, MA, PhD, Drmed 2008