Paraplegia

​Overview

Paraplegia refers to paralysis or weakness of the legs and/or trunk and below, frequently resulting from trauma or disease of the thoracic, lumbar, or sacral spine. Most spinal cord injuries (SCI’s) result in the loss of sensory, motor, and control of autonomic function (blood pressure, heart rate, temperature, and other “automatic” functions such as bowel, bladder, and respiration) below the level of injury. This frequently leads to some or all of the symptoms described below.

Symptoms

Symptoms of quadriplegia or tetraplegia may include:
  • Loss of sensation in the trunk and legs
  • Loss of ability to intentionally move the legs
  • Urinary incontinence
  • Bowel incontinence
  • Impotence
  • Difficulty generating a strong cough or managing secretions
  • Exaggerated reflexes in legs
  • Poorly controlled heart rate, blood pressure in response to certain stimuli
  • Pain below the level of the injury

Causes

Motor vehicle accidents are the leading cause of traumatic spinal cord injury (SCI). Other traumatic injuries, including falls, acts of violence, and sports injuries can also cause SCI.

A spinal cord injury may be acute, resulting in compression of the spinal cord, usually by bone fragments from fractures of the spinal column (vertebrae). There are many other possible causes for SCI, including congenital or age-related narrowing of the spinal canal, tumors of the spinal column causing chronic compression of the spinal cord or tumors of the spinal cord itself or its linings, loss of blood flow to the cord (ischemia), or various infections or inflammation of the cord or the structures around it. Very rarely is the spinal cord completely transected. However, because the spinal cord is very vulnerable to any trauma, even bruising in the cord may result in permanent injury.

Risk Factors

Narrowing of the spinal canal and compression of the spinal cord due to age-related changes of the spine or tumors that may metastasize to the spine (especially breast, lung, kidney, and prostate), infections of the epidural space, trauma or falls.

Diagnosis

A complete neuromuscular exam, along with imaging of the spine such as MRI or CT scan. Plain X-rays can confirm a fracture or narrowing of the canal, but cannot directly image the spinal cord.

Complications

Complications may include:
  • Requirement for equipment such as wheelchairs or other devices for primary mobility, transfers, to complete self-care, or for driving a vehicle.
  • Sexual function problems, including fertility in men.
  • Urinary and fecal storage or emptying problems, leading to retention/constipation or incontinence. This may require the use of catheters to drain the bladder and/or a regular bowel management program (involving oral medications, suppositories, enemas, or digital stimulation of the bowels).
  • Pressure ulcers
  • Pneumonia and other respiratory disorders
  • Blood clot formation in the arms/legs (DVT) or pulmonary embolism (blood clot that travels to the lung)
  • Spasticity (hyperactive reflexes, increased muscle tone, and spontaneous or easily elicited spasms) below the level of spinal injury
  • Contractures, or loss of flexibility of a joint
  • Nerve-related (neuropathic) pain, typically below the level of injury
  • Among those with injuries at or above T6: poor regulation of heart rate or blood pressure, especially in response to a painful stimulus (autonomic dysreflexia)

Recovery

More information on quadriplegia and Spinal Cord Injury is available at the following link: http://sci.washington.edu/info/pamphlets/index.asp

Related Articles