Spinal Şok Olgusunda Yoğun Bakım Yönetimi
Özet
Spinal şok, akut omurilik yaralanmasını takiben gelişen ve refleks, motor, duyusal ile otonom işlevlerde geçici kayıp ile karakterize bir tablodur. Bu bölümde spinal şokun tanımı, tarihsel arka planı ve klinik özellikleri ele alınmıştır. Refleks muayenesinin tanısal değeri, otonomik disfonksiyonların önemi ve yoğun bakım sürecinde hemodinamik stabilitenin sağlanması ile solunumsal desteğin temel ilkeleri vurgulanmıştır. Ayrıca, örnek bir olgu üzerinden klinik yaklaşımın pratik yönleri aktarılmıştır. Güncel literatür ışığında mikrodolaşımı hedefleyen farmakolojik girişimler ve kök hücre uygulamaları tartışılmış, böylece hem mevcut klinik yaklaşımlar hem de geleceğe yönelik tedavi stratejileri değerlendirilmiştir. Bu bütüncül bakış, spinal şokun tanı ve yönetiminde güncel bir çerçeve sunmaktadır.
Spinal shock is a clinical condition that occurs following acute spinal cord injury and is characterized by a transient loss of reflex, motor, sensory, and autonomic functions. This chapter outlines the definition, historical background, and clinical features of spinal shock. The diagnostic value of reflex examination, the significance of autonomic dysfunction, and the fundamental principles of maintaining hemodynamic stability and providing respiratory support in the intensive care setting are emphasized. In addition, the practical aspects of clinical management are illustrated through a case example. In light of current literature, pharmacological interventions targeting microcirculation and stem cell–based therapies are discussed, thereby addressing both current clinical approaches and future therapeutic strategies. This comprehensive perspective provides an up-to-date framework for the diagnosis and management of spinal shock.
Referanslar
Hall M. Second Memoir on some principles of the pathology of the nervous system. Medico-Chirurgical Transactions. 1840;23(1):121-67.
Burke RE. Sir Charles Sherrington's the integrative action of the nervous system: a centenary appreciation. Brain. 2007;130(Pt 4):887-94.
Sekhon LH, Fehlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine (Phila Pa 1976). 2001;26(24 Suppl):S2-12.
Wang TY, Park C, Zhang H, et al. Management of Acute Traumatic Spinal Cord Injury: A Review of the Literature. Frontiers in Surgery. 2021;8:698736.
Galeiras Vazquez R, Ferreiro Velasco ME, Mourelo Farina M, et al. Update on traumatic acute spinal cord injury. Part 1. Medicina Intensiva. 2017;41(4):237-47.
Ditunno JF, Little JW, Tessler A, et al.Spinal shock revisited: a four-phase model. Spinal Cord. 2004;42(7):383-95.
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis International. 2006;17(12):1726-33.
Silva NA, Sousa N, Reis RL,et al. From basics to clinical: a comprehensive review on spinal cord injury. Progress in Neurobiology
2014;114:25-57.
Oyinbo CA. Secondary injury mechanisms in traumatic spinal cord injury: a nugget of this multiply cascade. Acta Neurobiologiae Experimentalis. 2011;71(2):281-99.
Xu G. Concentrations of glutamate released following spinal cord injury kill oligodendrocytes in the spinal cord. Experimental Neurology. 2004;187(2):329-36.
Schreiner TG, Schreiner OD, Ciobanu RC. Spinal Cord Injury Management Based on Microglia-Targeting Therapies. Journal of Clinical Medicine. 2024;13(10):2773.
Ploughman M, Corbett D. Can forced-use therapy be clinically applied after stroke? An exploratory randomized controlled trial. Archives of Physical Medicine and Rehabilitation. 2004;85(9):1417-23.
Deforest BA, Bohorquez J, Perez MA. Vibration attenuates spasm‐like activity in humans with spinal cord injury. The Journal of Physiology. 2020;598(13):2703-17.
Ditunno JF, Little JW, Tessler A, et al Spinal shock revisited: a four-phase model. Spinal Cord. 2004;42(7):383-95.
Brockie S, Zhou C, Fehlings MG. Resident immune responses to spinal cord injury: role of astrocytes and microglia. Neural Regeneration Research, 2024;19(8):1678-85.
Li J, Wang P, Zhou T, et al. Neuroprotective effects of interleukin 10 in spinal cord injury. Frontiers in Molecular Neuroscience. 2023;16:1214294.
Ahuja CS, Mothe A, Khazaei M, et al. The leading edge: Emerging neuroprotective and neuroregenerative cell-based therapies for spinal cord injury. Stem Cells Translational Medicine. 2020;9(12):1509-30.
Calancie B, Molano MR, Broton JG. Tendon reflexes for predicting movement recovery after acute spinal cord injury in humans. Clinical Neurophysiology 2004;115(10):2350-63.
Ko HY. Revisit Spinal Shock: Pattern of Reflex Evolution during Spinal Shock. Korean Journal of Neurotrauma. 2018;14(2):47-54.
Dave S, Dahlstrom JJ, Weisbrod LJ. Neurogenic Shock. StatPearls. Treasure Island (FL): StatPearls Publishing
Copyright © 2025, StatPearls Publishing LLC.; 2025.
Wyndaele JJ, Quaghebeur J, Wyndaele M. What is the clinical meaning of a negative bulbocavernosus reflex in spinal cord injury patients? Spinal Cord Series and Cases. 2022;8(1):24.
Todd NV. Priapism in acute spinal cord injury. Spinal Cord. 2011;49(10):1033-5.
El-Kotob R, Craven BC, Mathur S, et al. Assessing Heart Rate Variability As a Surrogate Measure of Cardiac Autonomic Function in Chronic Traumatic Spinal Cord Injury. Topics in Spinal Cord Injury Rehabilitation. 2018;24(1):28-36.
Kyriakides A, Poulikakos D, Galata A,et al. The effect of level of injury and physical activity on heart rate variability following spinal cord injury. Journal of Spinal Cord Medicine. 2019;42(2):212-9.
Malmqvist L, Biering-Sorensen T, Bartholdy K, et al. Assessment of autonomic function after acute spinal cord injury using heart rate variability analyses. Spinal Cord. 2015;53(1):54-8.
Maqsood R, Khattab A, Bennett AN,et al. Association between non-acute traumatic injury (TI) and heart rate variability (HRV) in adults: A systematic review protocol. Plos One. 2022;17(8):e0273688.
Eschlbock S, Wenning G, Fanciulli A. Evidence-based treatment of neurogenic orthostatic hypotension and related symptoms. ı: Journal of Neural Transmission (Vienna). 2017;124(12):1567-605.
Illman A, Stiller K, Williams M. The prevalence of orthostatic hypotension during physiotherapy treatment in patients with an acute spinal cord injury. Spinal Cord. 2000;38(12):741-7.
Furlan JC, Fehlings MG. Cardiovascular complications after acute spinal cord injury: pathophysiology, diagnosis, and management. Neurosurg Focus. 2008;25(5):E13.
Faghri PD, Yount JP, Pesce WJ,et al. Circulatory hypokinesis and functional electric stimulation during standing in persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation. 2001;82(11):1587-95.
Henke AM, Billington ZJ, Gater DR. Autonomic Dysfunction and Management after Spinal Cord Injury: A Narrative Review. Journal of Personalized Medicine. 2022;12(7):1110.
Linsenmeyer TA, Gibbs K, Solinsky R. Autonomic Dysreflexia After Spinal Cord Injury: Beyond the Basics. Current Physical Medicine and Rehabilitation Reports. 2020;8(4):443-51.
Martínez-Torija M, Esteban PF, Santos-De-La-Mata A, et al.Multifaceted Pathophysiology and Secondary Complications of Chronic Spinal Cord Injury: Focus on Pressure Injury. Journal of Clinical Medicine. 2025;14(5):1556.
Krassioukov A, Linsenmeyer TA, Beck LA, et al. Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions: Preventing the Highs and Lows: Management of Blood Pressure, Sweating, and Temperature Dysfunction. Top Spinal Cord Inj Rehabil. 2021;27(2):225-90.
Krassioukov A, Stillman M, Beck LA. A Primary Care Provider's Guide to Autonomic Dysfunction Following Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2020;26(2):123-7.
Wecht JM, Harel NY, Guest J, et al. Cardiovascular Autonomic Dysfunction in Spinal Cord Injury: Epidemiology, Diagnosis, and Management. Semin Neurol. 2020;40(5):550-9.
Benarroch EE. Physiology and Pathophysiology of the Autonomic Nervous System. Continuum: Lifelong Learning in Neurology
2020;26(1):12-24.
Wecht JM, Krassioukov AV, Alexander M, et al. International Standards to document Autonomic Function following SCI (ISAFSCI): Second Edition. Top Spinal Cord Inj Rehabil. 2021;27(2):23-49.
Morrison SF, Nakamura K. Central neural pathways for thermoregulation. Frontiers in Bioscience – Landmark Edition. 2011;16(1):74-104.
Phillips AA, Squair JW, Sayenko DG, et al. An Autonomic Neuroprosthesis: Noninvasive Electrical Spinal Cord Stimulation Restores Autonomic Cardiovascular Function in Individuals with Spinal Cord Injury. Journal of Neurotrauma
2018;35(3):446-51.
Grossmann F, Flueck JL, Perret C, et al. The Thermoregulatory and Thermal Responses of Individuals With a Spinal Cord Injury During Exercise, Acclimation and by Using Cooling Strategies-A Systematic Review. Frontiers in Physiology. 2021;12:636997.
West CR, Alyahya A, Laher I, et alPeripheral vascular function in spinal cord injury: a systematic review. Spinal Cord. 2013;51(1):10-9.
Savage KE, Oleson CV, Schroeder GD, et al. Neurogenic Fever after Acute Traumatic Spinal Cord Injury: A Qualitative Systematic Review. Global Spine Journal. 2016;6(6):607-14.
Ulger F, Pehlivanlar Kucuk M, Ozturk CE, et al. Non-infectious Fever After Acute Spinal Cord Injury in the Intensive Care Unit. Journal of Spinal Cord Medicine. 2019;42(3):310-7.
Smith TM, Berk AS, Upadhyay H. Severe hypothermia in a patient with spinal cord injury without radiological abnormality. Journal of Spinal Cord Medicine. 2011;4(3):421-4.
Garstang SV, Miller-Smith SA. Autonomic Nervous System Dysfunction After Spinal Cord Injury. Physical Medicine and Rehabilitation Clinics of North America. 2007;18(2):275-96.
Schilero GJ, Bauman WA, Radulovic M. Traumatic Spinal Cord Injury: Pulmonary Physiologic Principles and Management. Clin Chest Med. 2018;39(2):411-25.
Henzel MK, Shultz JM, Dyson-Hudson TA, et al. Initial assessment and management of respiratory infections in persons with spinal cord injuries and disorders in the COVID-19 era. Journal of the American College of Emergency Physicians Open. 2020;1(6):1404-12.
Kouwijzer I, Cowan RE, Maher JL, et al. Interrater and intrarater reliability of ventilatory thresholds determined in individuals with spinal cord injury. Spinal Cord. 2019;57(8):669-78.
Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Diagnosis and Evaluation. : The Journal of Urology. 2021;206(5):1097-105.
Ibrahim E, Lynne CM, Brackett NL. Male fertility following spinal cord injury: an update. Andrology. 2016;4(1):13-26.
Pereira L. Obstetric management of the patient with spinal cord injury. Obstetrical & Gynecological Survey.2003;58(10):678-87.
American College of Obstetricians and Gynecologists.
Obstetric Management of Patients with Spinal Cord Injuries: ACOG Committee Opinion, Number 808. Obstetrics & Gynecology. 2020;135(5):e230-e6.
Hadley MN, Walters BC, Grabb PA, et al. Blood pressure management after acute spinal cord injury. Neurosurgery. 2002;50(3 Suppl):S58-62.
Yue JK, Tsolinas RE, Burke JF, et al. Vasopressor support in managing acute spinal cord injury: current knowledge. J Neurosurg Sci. 2019;63(3):308-17.
Thomas AX, Riviello JJ, Davila-Williams D, et al. Pharmacologic and Acute Management of Spinal Cord Injury in Adults and Children. Current Treatment Options in Neurology. 2022;24(7):285-304.
Ahmed Ali AT, Abd El-Aziz MA, Mohamed Abdelhafez A,et al. Effect of Oral Vasopressors Used for Liberation from Intravenous Vasopressors in Intensive Care Unit Patients Recovering from Spinal Shock: A Randomized Controlled Trial. Critical Care Research and Practice. 2022;2022:6448504.
Bilello JF, Davis JW, Cunningham MA, et al. Cervical spinal cord injury and the need for cardiovascular intervention. Archives of Surgery. 2003;138(10):1127-9.
Bracken MB, Shepard MJ, Collins WF, et al. Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second National Acute Spinal Cord Injury Study. Journal of Neurosurgery. 1992;76(1):23-31.
Cheung V, Hoshide R, Bansal V, et al. Methylprednisolone in the management of spinal cord injuries: Lessons from randomized, controlled trials. Surgical Neurology International. 2015;6(1):142.
Hurlbert RJ, Hadley MN, Walters BC, et al. Pharmacological therapy for acute spinal cord injury. Neurosurgery. 2013;72 Suppl 2(supplement 2):93-105.
Stokes S, Drozda M, Lee C. The past, present, and future of traumatic spinal cord injury therapies: a review. Bone & Joint Open . 2022;3(5):348-58.
Huang YH, Yang TM, Lin WC, et al. The prognosis of acute blunt cervical spinal cord injury. Journal of Trauma and Acute Care Surgery. 2009;66(5):1441-5.
Lohana AC, Neel S, Deepak V, et al. Intrathecal iodinated contrast-induced transient spinal shock. BMJ Case Reports. 2020;13(12):e237610.
Lee BJ, Jeong JH. Early Decompression in Acute Spinal Cord Injury : Review and Update. Journal of Korean Neurosurgical Society . 2023;66(1):6-11.
Velmahos GC, Kern J, Chan LS, et al. Prevention of venous thromboembolism after injury: an evidence-based report--part II: analysis of risk factors and evaluation of the role of vena caval filters. Journal of Trauma and Acute Care Surgery 2000;49(1):140-4.
Jia X, Kowalski RG, Sciubba DM, Geocadin RG. Critical care of traumatic spinal cord injury. Journal of Intensive Care Medicine (JICM). 2013;28(1):12-23.
