**2.1 Spinal shock versus neurogenic shock**

Although "spinal shock" and "neurogenic shock" are used interchangeably to optimize the outcome, there is a need to identify these two entities separately. Neurogenic shock is characterized by the hemodynamic changes resulting from spinal cord injury (above T6) and a loss of autonomic tone resulting in hypotension and bradycardia [4]. In a broader perspective, neurogenic shock is a distributive shock characterized by hypotension, bradycardia, and peripheral vasodilatation. It can manifest following a significant central nervous system damage (head injury, cervical spinal cord, or high thoracic cord injuries) [4]. **Table 1** shows a comparative description of these two types of shock, frequently encountered in trauma patients [19–22]. In clinical practice, early identification of spinal shock relieves the patient's anxiety and better prognostication of the sequela following spine injury.


**Table 1.**

*Comparison between spinal shock and neurogenic shock.*

### **2.2 Management**

In the majority, spinal shock is associated with traumatic spinal cord injuries and requires a comprehensive interprofessional team approach (consisting of emergency teams, neurosurgeons, neuro-rehabilitation experts, and social workers). Imaging evaluation includes magnetic resonance imaging (MRI) and a detailed spinal computed tomogram (CT) with bony details. Before performing the detailed imaging, initial evaluation, and management follow the protocol to manage any patient who presents to the emergency room and manage "Airway, Breathing and Circulation" [23]. These patients may need intubation, mechanical ventilation, central venous access, invasive monitoring, and vasopressors to manage hemodynamic instability and neurogenic shock. They may require management of the source of hemorrhage, pneumothorax, myocardial injury, pericardial tamponade, or any other source of hypotension [23, 24]. Patients with a high cervical injury who present with spinal shock shall need special attention as these may frequently require cardiovascular interventions, including pacemakers for symptomatic bradycardia [25]. Elective ventilation or early tracheostomy to prevent or manage respiratory complications [26]. These patients shall need nutritional support, prophylaxis to prevent gastric ulcers, deep vein thrombosis, a long-term indwelling urinary catheter for bladder dysfunction, toilet training for bowel dysfunction, and care from preventing pressure ulcers [6, 7].

### **2.3 Outcome**

Although there is improved survival in the patients, the severity of neurological deficits determines the overall outcome of these patients [6–8]. Overall, spinal cord injury and shock are associated with poorer functional and overall outcomes requiring long-term rehabilitation care [15, 27].
