Pathophysiology, Classification and Comorbidities after Traumatic Spinal Cord Injury

Abstract

The spinal cord is a conduit within the central nervous system (CNS) that provides ongoing communication between the brain and the rest of the body, conveying complex sensory and motor information necessary for safety, movement, reflexes, and optimization of autonomic function. After a spinal cord injury (SCI), supraspinal influences on the spinal segmental control system and autonomic nervous system (ANS) are disrupted, leading to spastic paralysis, pain and dysesthesia, sympathetic blunting and parasympathetic dominance resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions and uncontrolled bowel, bladder, and sexual dysfunction. This article outlines the pathophysiology of traumatic SCI, current and emerging methods of classification, and its influence on sensory/motor function, and introduces the probable comorbidities associated with SCI that will be discussed in more detail in the accompanying manuscripts of this special issue.

Keywords: autonomic dysfunction; comorbidities; paraplegia; regeneration; spinal cord injury; tetraplegia.

Figure 1

The Figure illustrates the pathophysiological events that accompany excitotoxicity including mitochondrial stress, elevated Ca²⁺ with associated enzyme activation and cell death. Reprinted from Ref. [69].