**6. Conclusions**

It is important to distinguish the differences between spinal shock and neurogenic shock, both in terms of definitions and clinical manifestations. Spinal shock encompasses a diverse set of injuries involving various parts of the spinal


**119**

**Figure 2.**

*of Biorender®.*

**Figure 1.**

*Spinal Shock: Differentiation from Neurogenic Shock and Key Management Approaches*

cord, whereas neurogenic shock tends to be a result of spinal injuries above the level of T6. Spinal shock occurs in phases (I–IV) that are temporally distributed over a period of weeks to months, whereas neurogenic shock tends to have sudden onset that requires more urgent management. **Table 3** outlines the key differences between spinal and neurogenic shock. Patients with SS and injuries above the level of T6 should always be evaluated for neurogenic shock symptoms, such as

*This represents the different tracts on a T8 spinal cross section. The sensory pathways (S) and motor pathways (M) are identified with specific characteristics depicted on the right. This image was created using Biorender* 

*Image representing lesion that would be considered Brown-Sequard and the pathways involved in the hemisection injury. This image was created using Biorender and is used here based on the terms and conditions* 

*and is used here based on the terms and conditions of Biorender®.*

*DOI: http://dx.doi.org/10.5772/intechopen.92026*

#### **Table 3.**

*Spinal shock versus neurogenic shock.*

*Spinal Shock: Differentiation from Neurogenic Shock and Key Management Approaches DOI: http://dx.doi.org/10.5772/intechopen.92026*

cord, whereas neurogenic shock tends to be a result of spinal injuries above the level of T6. Spinal shock occurs in phases (I–IV) that are temporally distributed over a period of weeks to months, whereas neurogenic shock tends to have sudden onset that requires more urgent management. **Table 3** outlines the key differences between spinal and neurogenic shock. Patients with SS and injuries above the level of T6 should always be evaluated for neurogenic shock symptoms, such as

#### **Figure 1.**

*Clinical Management of Shock - The Science and Art of Physiological Restoration*

basis to prevent contractions and spastic paralysis [128].

and occupational rehabilitation course [121].

**5.4 Posterior cord syndrome**

**6. Conclusions**

Systemic hypotension

*Spinal shock versus neurogenic shock.*

incomplete SCI, with only 10–20% of patients achieving some level of functional recovery [126]. ACS has two primary pathogenetic mechanisms. In about 90% of cases, it is caused by decreased vascular perfusion to the anterior spinal artery which supplies the anterior 2/3 of the spinal cord [95, 126]. Another possible cause is from increased direct pressure on the spinal cord caused by compression trauma or "over-flexion" [127]. The first signs of ACS include bilateral loss of motor function, pain, and temperature sensation. These findings are more dominant in the lower extremities. Patients also tend to present with loss of bladder and bowel function [126]. Presentation of ACS is usually acute with severe back pain and loss of neurologic function mentioned. The best confirmatory test is a spinal MRI; however, computed tomography angiography (CTA) may be used for faster diagnosis. Emergent surgical management may be required depending on the underlying pathology responsible for the ACS (e.g., aortic aneurysm). Once the underlying condition is treated, management of ACS is similar to other SCIs and consists of physical and occupational therapy. While the patient may never regain the lost motor and sensory function, it is vital that physical therapy is provided on a regular

Posterior cord syndrome (PCS) has an incidence of roughly <1% [95, 99]. Like ACS it carries a very poor prognosis. The causes of PCS include vascular compromise to the posterior spinal artery, trauma, multiple sclerosis (MS), vitamin B12 deficiency, and syphilis. Since PCS affects the posterior aspect of the spinal cord containing dorsal column fibers, one typically sees presentations that involve loss of proprioception and vibratory sensation with motor function being preserved. Patients occasionally will have sensation of "electric shocks" running down their spine, which is known as Lhermitte's sign and can indicate MS or a metabolic deficiency [121, 128]. CTA might allow for rapid diagnosis of vascular comprise/ threat and allow for emergent treatment. However, MRI imaging showing infarctions is the most reliable method of confirming the diagnosis [99]. Once the underlying pathology is treated, PCS management will require rigorous physical

It is important to distinguish the differences between spinal shock and neurogenic shock, both in terms of definitions and clinical manifestations. Spinal shock encompasses a diverse set of injuries involving various parts of the spinal

Damage location Different areas of the spinal cord Sympathetic pathways—above T6

Possible, depending on the location and

severity of injury

Onset time Sudden to days Sudden Time to resolution Weeks to months Hours to days

**Spinal shock Neurogenic shock**

vertebral level

Always

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**Table 3.**

*This represents the different tracts on a T8 spinal cross section. The sensory pathways (S) and motor pathways (M) are identified with specific characteristics depicted on the right. This image was created using Biorender and is used here based on the terms and conditions of Biorender®.*

#### **Figure 2.**

*Image representing lesion that would be considered Brown-Sequard and the pathways involved in the hemisection injury. This image was created using Biorender and is used here based on the terms and conditions of Biorender®.*

hypotension, hypothermia, and bradycardia. Both complete and incomplete SS injuries can develop hypotension but will not develop systemic vasodilation (as would be seen in the event of neurogenic shock). Accurately differentiating neurogenic and spinal shock is important because it will help clinicians in determining important management decisions in patients with SCI (**Figures 1**–**5**).

#### **Figure 3.**

*Image represents central cord injury and the pathways involved. This image was created using Biorender and is used here based on the terms and conditions of Biorender®.*

#### **Figure 4.**

*Image represents anterior cord injury and the pathways involved. This image was created using Biorender and is used here based on the terms and conditions of Biorender®.*

**121**

**Glossary**

**Figure 5.**

SS spinal shock SCI spinal cord injury DTR deep tendon reflex DPR deep plantar reflex CM cremasteric KJ knee jerk

BC bulbocavernosus AJ ankle jerk AW anal wink

CCS central cord syndrome BSS Brown-Sequard syndrome ACS anterior cord syndrome PCS posterior cord syndrome CSF cerebrospinal fluid

*is used here based on the terms and conditions of Biorender®.*

*Spinal Shock: Differentiation from Neurogenic Shock and Key Management Approaches*

*Image represents posterior cord injury and the pathways involved. This image was created using Biorender and* 

*DOI: http://dx.doi.org/10.5772/intechopen.92026*

*Spinal Shock: Differentiation from Neurogenic Shock and Key Management Approaches DOI: http://dx.doi.org/10.5772/intechopen.92026*

#### **Figure 5.**

*Clinical Management of Shock - The Science and Art of Physiological Restoration*

important management decisions in patients with SCI (**Figures 1**–**5**).

hypotension, hypothermia, and bradycardia. Both complete and incomplete SS injuries can develop hypotension but will not develop systemic vasodilation (as would be seen in the event of neurogenic shock). Accurately differentiating neurogenic and spinal shock is important because it will help clinicians in determining

*Image represents central cord injury and the pathways involved. This image was created using Biorender and is* 

*Image represents anterior cord injury and the pathways involved. This image was created using Biorender and* 

**120**

**Figure 4.**

**Figure 3.**

*used here based on the terms and conditions of Biorender®.*

*is used here based on the terms and conditions of Biorender®.*

*Image represents posterior cord injury and the pathways involved. This image was created using Biorender and is used here based on the terms and conditions of Biorender®.*

### **Glossary**

