Persons with spinal cord injury (SCI) have secondary medical consequences of paralysis and/or the consequences of extreme inactivity. The metabolic changes that result from reduced activity include insulin resistance with carbohydrate disorders and dyslipidemia. A higher prevalence of coronary artery calcification was found in persons with SCI than that in matched able-bodied controls. A depression in anabolic hormones, circulating testosterone and growth hormone, has been described. Adverse soft tissue body composition changes of increased adiposity and reduced skeletal muscle are appreciated. Immobilization is the cause for sublesional disuse osteoporosis with an associated increased risk of fragility fracture. Bowel dysmotility affects all segments of the gastrointestinal tract, with an interest in better defining and addressing gastroesophageal reflux disease and difficulty with evacuation. Developing and testing more effective approaches to cleanse the bowel for elective colonoscopy are being evaluated. The extent of respiratory dysfunction depends on the level and completeness of SCI. Individuals with higher spinal lesions have both restrictive and obstructive airway disease. Pharmacological approaches and expiratory muscle training are being studied as interventions to improve pulmonary function and cough strength with the objective of reducing pulmonary complications. Persons with spinal lesions above the 6th thoracic level lack both cardiac and peripheral vascular mechanisms to maintain blood pressure, and they are frequently hypotensive, with even worse hypotension with upright posture. Persistent and/ or orthostatic hypotension may predispose those with SCI to cognitive impairments. The safety and efficacy of anti-hypotensive agents to normalize blood pressure in persons with higher level cord lesions is being investigated.
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Original Article|
September 20 2012
31st G. Heiner Sell Lectureship: Secondary Medical Consequences of Spinal Cord Injury
William Bauman;
William Bauman
1
VA RR&D National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York
2
Medical Service, James J. Peters VA Medical Center, Bronx, New York
3
Department of Medicine, The Mount Sinai School of Medicine, New York, New York
4
Department of Rehabilitation, The Mount Sinai School of Medicine, New York, New York
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Mark Korsten;
Mark Korsten
1
VA RR&D National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York
2
Medical Service, James J. Peters VA Medical Center, Bronx, New York
3
Department of Medicine, The Mount Sinai School of Medicine, New York, New York
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Miroslav Radulovic;
Miroslav Radulovic
1
VA RR&D National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York
2
Medical Service, James J. Peters VA Medical Center, Bronx, New York
3
Department of Medicine, The Mount Sinai School of Medicine, New York, New York
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Gregory Schilero;
Gregory Schilero
1
VA RR&D National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York
2
Medical Service, James J. Peters VA Medical Center, Bronx, New York
3
Department of Medicine, The Mount Sinai School of Medicine, New York, New York
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Jill Wech;
Jill Wech
1
VA RR&D National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York
2
Medical Service, James J. Peters VA Medical Center, Bronx, New York
3
Department of Medicine, The Mount Sinai School of Medicine, New York, New York
4
Department of Rehabilitation, The Mount Sinai School of Medicine, New York, New York
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Ann Spungen
Ann Spungen
1
VA RR&D National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York
2
Medical Service, James J. Peters VA Medical Center, Bronx, New York
3
Department of Medicine, The Mount Sinai School of Medicine, New York, New York
4
Department of Rehabilitation, The Mount Sinai School of Medicine, New York, New York
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Top Spinal Cord Inj Rehabil (2012) 18 (4): 354–378.
Citation
William Bauman, Mark Korsten, Miroslav Radulovic, Gregory Schilero, Jill Wech, Ann Spungen; 31st G. Heiner Sell Lectureship: Secondary Medical Consequences of Spinal Cord Injury. Top Spinal Cord Inj Rehabil 1 October 2012; 18 (4): 354–378. doi: https://doi.org/10.1310/sci1804-354
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