Paraplegia

For maximum independence in everyday life

A serious accident during sports or in traffic: If the nerve tracts in the spinal cord are injured, this has the worst effects and consequences for those affected. The diagnosis “paraplegia” is a severe shock to them and life changes abruptly. While the number of occupational accidents has fallen by more than a third thanks to the precautionary measures of the employers’ liability insurance associations, the number of patients injuring the spinal cord in their free time is increasing. Non-traumatic causes, such as circulatory problems, tumours or infections, can damage the spinal cord.

At Schoen Clinic, we specialise the diagnosis and treatment of conditions of the central and peripheral nervous system. Every paraplegia patient receives an individual treatment plan to treat his functional disorders.

Causes & symptoms

What is paraplegia?

Paraplegia is the result of spinal cord damage. The spinal cord is located in the spinal canal and is part of the central nervous system. It passes on information between the brain and the body. If damage occurs, the line is interrupted and usually cannot be restored.

In terms of the extent of the injury, a distinction is made between:

  • Paraplegia: This corresponds to damage in the thoracic region or below and means paralysis of both legs. This is also referred to as low-level paralysis. The upper extremities remain functional; in most cases, the respiratory muscles are not or only slightly affected.
  • Quadriplegia: Here, both the legs and arms, and the arm muscles are paralysed, the damage is in the region of the cervical spine. This is also referred to as high-level paralysis. Affected patients must also be artificially ventilated if the spinal cord is interrupted at the level of the fourth cervical vertebra or higher.

Causes: how paraplegia develops

As a rule, fractures of the spine, usually as a result of an accident, cause paraplegia. Due to this, vertebral bodies move and the spinal cord is squeezed. Tissue swelling and bruising can lead to damage to the spinal cord. In the process, a scar is formed at this point, but the original connections are broken and cannot be restored.

In addition to forces acting on the spine, diseases of the spinal cord or the surrounding structures can indirectly lead to a disorder. These include tumour diseases, infections and diseases of the blood vessels, such as stroke or multiple sclerosis.

Paraplegia can also be congenital, as in the case of spina bifida, which results from a malformation of the nervous system in the embryonic phase.

But a herniated disc can lead to a spinal cord injury. Normally, pressure by the intervertebral disc on the spinal cord only paralyses individual muscles. In the worst case, however, the spinal cord can be squeezed.

Symptoms: Indications of paraplegia

Muscular failure in the form of paralysis is the most obvious symptom of paraplegia. The extent depends on how badly the spinal cord is damaged. A spinal cord injury as such does not hurt. The pain is instead caused by broken vertebrae or soft tissue injuries.

There are two types of paralysis:

  • Incomplete paralysis Not all nerve tracts are affected here. Despite paralysis of the musculature, sensitivity, i.e. the emotional sensation (pain, cold, heat or touch) can be intact and vice versa.
  • Complete paralysis Patients don’t have the urge to pass stools or urinate. There is no sensitivity in the area of the inside of the thighs and contraction of the anal muscle is not possible.

In the first few weeks, affected persons are in what is known as a spinal shock state. This leads to complete flaccid paralysis and a loss of muscle stretching and polysynaptic reflexes. The flaccid paralysis can last up to six weeks and is relieved very slowly. Only then can the extent of spinal cord damage be determined.

Further symptoms of paraplegia

Pressure sores are also typical as a result of excessive pressure on the skin. The skin is trapped between the base and the bones and therefore receives an insufficient supply of blood. Since pain is no longer perceived, no change in position is triggered. It mainly affects areas of the body where there is little soft tissue between the skin and bone, such as the buttocks.

Spasticity also occurs in many patients. Here, the harmonious interaction of flexor and extensor muscles is disturbed, fine movements are difficult or impossible. After several weeks and months of spinal cord damage, the muscle’s state of tension increases gradually.

Nerve pain develops in up to half of all people affected. This can express itself, for example, in a burning, tingling or electrifying feeling.
Due to the lack of movement and bone load, 60 per cent of all patients develop osteoporosis . This leads to a continuous dissolving of bone in the first two years after the trauma.

Diagnostics

How we diagnose paraplegia

First, our consultants determine the cause of the paraplegia. If the spinal cord damage was caused by an accident, the patients are first asked about the exact course of the accident as well as the beginning and duration of the symptoms. Here, the doctor tests the person’s motor skills and the sensitivity of the body and limbs. He also checks the reflexes. In addition, he examines disorders of the bladder and rectum and clarifies any previous illnesses. Any other possible neurological deficits are also examined.

Differential diagnosis of non-traumatic paraplegia

In the case of paraplegia that occurred without an accident, what is known as a differential diagnosis is also required. The doctor checks whether and to what extent other diseases are present that lead to paralysis and are not caused by spinal cord damage. This means that, in addition to changes in the structure of the spinal cord, diseases of the brain, such as inflammation of the nervous system, must also be taken into account.

X-rays decide on an operation

Imaging procedures, such as spinal X-ray, computed tomography or magnetic resonance imaging of the spinal cord, provide information about bony injuries and damage to the spinal cord. Only after these examinations can a decision be made as to whether an operation is appropriate.