Management of chronic spinal cord dysfunction

Abstract

Purpose of review: Both acute and chronic spinal cord disorders present multisystem management problems to the clinician. This article highlights key issues associated with chronic spinal cord dysfunction.

Recent findings: Advances in symptomatic management for chronic spinal cord dysfunction include use of botulinum toxin to manage detrusor hyperreflexia, pregabalin for management of neuropathic pain, and intensive locomotor training for improved walking ability in incomplete spinal cord injuries.

Summary: The care of spinal cord dysfunction has advanced significantly over the past 2 decades. Management and treatment of neurologic and non-neurologic complications of chronic myelopathies ensure that each patient will be able to maximize their functional independence and quality of life.

Figure 11-1

Detrusor pressure with simultaneous EMG of sphincter during slow infusion of fluid into bladder. In the healthy adult patient (upper graph), note the change in sphincter tone with starting and stopping of normal voluntary voiding. In the paraplegic patient (lower graph), there is abnormal increase in sphincter pressure with reflex voiding resulting in elevated detrusor pressures. Modified from Fowler CJ, et al, Nat Rev Neurosci. © 2008 The Authors. www.nature.com/nrn/journal/v9/n6/abs/nrn2401.html.