[Spinal shock. Diagnosis and therapy. Problems and dilemmas]

Spinal shock is the term used to signify the effect of sudden injury or transection of the spinal cord. It is characterized by sensory, motor and reflex loss occurring below the level of injury. High level spinal injuries are associated with loss of autonomous nerve system control. This condition still remains an enigma which challenges the neurophysiologists, clinical neurologists and the spinal surgeons. There are many different theories relating to the cause and nature of spinal shock as well as to the level of spinal injury that results in spinal shock. Duration of spinal shock varies from patient to patient, and some of the symptoms can last up to 12 weeks. Clinical presentation of spinal shock involves changes in skeletal muscles, sensory response, breathing, heart, blood vessels, vasomotor response, body temperature, GI tract, urinary bladder and genitalia. Somatosensory evoked potentials also reflect changes caused by spinal shock. The clinician's task is to treat clinical symptoms provoked by spinal shock in an attempt to reduce its intensity and duration. This can be achieved by operative and medicamentous therapy, promptness and efficacy being the treatment imperatives. The authors discuss diagnostic and therapeutic methods used in the treatment of spinal shock and present their own experience and viewpoints in terms of reduction of spinal shock intensity and duration.