Paraplegia

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.

Differential diagnosis of non-traumatic paraplegia

X-rays decide on an operation