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Complications

There are many potential long‐term complications that may occur during or after moving and positioning MSCC patients. These are due to initial injury, the subsequent effects of changes in bowel and bladder functions and paralysis (complete loss of motor function) associated with their disease or injury through autonomic and peripheral nervous system dysfunction, and those associated with bedrest (Furlan et al. [89], Kaplow and Iyere [125]).

Spinal shock

Following initial injury or lesion development, spinal shock can occur due to the loss of vasomotor tone throughout the paralyzed areas of the body. This is most pronounced in cases of tetraplegia. Patients present with hypotension, bradycardia and poikilothermia (having a body temperature that varies with the temperature of the surroundings). This is due to a temporary or permanent loss of reflexes and muscle tone and control potentially leading to a compromised cardiac output. The patient must be closely monitored throughout and following any procedure or transfer, as recommended by medical staff (Furlan et al. [89]).

Autonomic dysfunction

Following injury or lesion development, secondary effects occur due to autonomic dysfunction, a potential complication for all patients with complete spinal cord lesions above the level of T6 (see Problem‐solving table 26.16) (Kaplow and Iyere [125]).

Autonomic dysreflexia

This is a mass reflex due to excessive activity of the sympathetic nervous system elicited by noxious stimuli below the level of the lesion. It is a medical emergency and, unresolved, it can cause fatal cerebral haemorrhage. Patients present with severe hypertension (abrupt rise in blood pressure), systolic blood pressure that can easily exceed 200 mmHg, bradycardia, ‘pounding’ headache, flushed or blotchy appearance of skin above the level of lesion, profuse sweating above the level of lesion, pallor below the level of lesion, nasal congestion and non‐drainage of urine (Milligan et al. [182]).

Orthostatic hypotension

There is an extreme fall in blood pressure on assuming an upright position (systolic > 20 mmHg, diastolic > 10 mmHg). It is more common in tetraplegia than quadriplegia (Krassioukov et al. [136], Lundy‐Ekman [155]).

Poor thermoregulation

There is compensatory sweating above the level of lesion and loss of ability to shiver below the level of lesion. Patients should avoid exposure to excessive heat/cold temperatures; peripheral vasodilation means that the patient's core temperature can soon equal the environmental temperature through circulatory conduction poikilothermia. Ensure that the patient's body temperature is maintained at an appropriate level during all procedures, treatments, investigations and transfers. Active warming should be undertaken cautiously for fear of causing skin damage (Harrison [105]).

Pressure care

There is a risk to skin integrity and the development of pressure sores due to a lack of movement, poor circulation and altered sensation (Kaplow and Iyere [125]).

Circulation

There is a risk of DVT due to the loss of vasomotor tone throughout the paralyzed areas of the body. Application of thigh‐length thromboembolic deterrent (TED) stockings can replace some of the lost muscle resistance, as well as reducing the risk of DVT (Harrison [105]).