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The pattern of reflex recovery during spinal shock
H Y Ko1, J F Ditunno, V Graziani
1Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University College of Medicine, Korea.
Spinal Cord
|August 4, 1999
Summary
Early reflex recovery patterns after spinal cord injury (SCI) offer prognostic insights for ambulation. The delayed plantar response (DPR) duration is a key indicator, suggesting traditional spinal shock concepts may be outdated for clinical use.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Spinal Cord Injury Research
Background:
- Acute spinal cord injury (SCI) disrupts neurological function, necessitating understanding of recovery patterns.
- Spinal shock, characterized by absent reflexes, is a traditional concept, but its prognostic utility requires re-evaluation.
- Early reflex assessment is crucial for predicting functional outcomes, particularly ambulation.
Purpose of the Study:
- To observe the pattern of reflex recovery following acute SCI.
- To determine the prognostic significance of reflexes for ambulation.
- To investigate the relationship between reflex recovery and spinal shock.
Main Methods:
- A prospective descriptive study conducted at a regional SCI center.
- Fifty consecutive patients admitted on the day of injury were monitored for specific reflexes (bulbo-cavernosis, delayed plantar response, cremasteric, ankle jerk, knee jerk) over 6-8 weeks.
- Ambulation of 200 feet at discharge and MRI findings for complete injuries were assessed.
Main Results:
- A delayed plantar response (DPR) of 2 days or longer duration was associated with non-ambulation (35/50 subjects).
- Ambulatory subjects (14/50) typically had no DPR or a DPR of only 1 day's duration.
- The DPR was the first reflex to recover in most cases, followed by other reflexes; recovery did not follow a strict caudal-rostral pattern.
Conclusions:
- Prognosis for ambulation based on early reflexes post-SCI should not rely solely on traditional spinal shock descriptions.
- The concept of spinal shock, particularly its caudal-rostral reflex recovery sequence, has limited clinical utility.
- The evolution of reflexes over several days post-injury is more relevant for predicting ambulation outcomes than reflex presence/absence on the day of injury.