Fig. 2

Neurological disruption in SCI. After SCI, there is global neurological impairment affecting the CNS, PNS and ANS. The PNS is altered after SCI due to the loss of neuronal bodies in the GM involved in sensory (posterior horn) and motor processing (anterior horn). Peripheral nerves are broadly affected after SCI, showing significant physiological changes and structural abnormalities. Regarding the CNS, SCI may lead to deafferentation and the loss of brain-spinal cord communication, creating functional and structural changes in both structures. In addition, cell death can be transmitted above and below the site of injury, explaining the progressive dysfunction of the CNS. All these mechanisms promote central neuropathic pain, a detrimental consequence also derived from secondary mechanisms of SCI. Finally, autonomic dysfunction is related to the breakdown of sympathetic and parasympathetic balance, having detrimental consequences in the ENS. This leads to notable serious concerns such as cardiac dysrhythmias and systemic hypotension. However, perhaps the most worrisome consequence of autonomic dysfunction is autonomic dysreflexia, a potentially lethal disorder mostly occurring in patients with high SCI (≥ T₆). SCI Spinal cord injury; CNS Central nervous system; PNS Peripheral nervous system; ANS Autonomic nervous system; GM Gray matter; ENS Enteric nervous system