Paraplegia

Synonyms in a broader sense

Paraplegic syndrome, paraplegic lesion, transverse syndrome Medical: Paraplegia, (spinal)

Definition

Paraplegia is not a disease, but a combination of symptoms that occur as a result of an interruption in the nerve conduction of the spinal cord. Together with the brain, the spinal cord forms the central nervous system (CNS). It extends from above the first cervical vertebra to approximately above the second lumbar vertebra and lies protected in a bony channel, the spinal canal, which is located within the spinal column.

On the one hand, the spinal cord transmits commands from the brain to the muscles, but on the other hand it also carries information about touch, pain or the position of limbs from the body back to the brain. It also contains nerves that are responsible for controlling internal organs, i.e. it also controls processes that occur largely unconsciously, such as digestion or heart rate (autonomic nervous system). If the spinal cord is severed as a result of an injury, the above-mentioned functions are lost below the injury, i.e. not only paralysis (loss of motor function), but also damage to the sensitive and vegetative components, which is why the word paraplegic syndrome describes this condition more accurately than the term paraplegia. In Germany every year 1000 to 1500 people are newly affected by paraplegia, 80% of which occur in men. The most common cause (about 70%) are accidents, of which again by far the most common type are car accidents.

Forms of paraplegia

There are different forms of paraplegia. One distinguishing feature is at what spinal cord height the injury occurred. One speaks of paraplegia when the spinal cord is severed in the thoracic vertebrae or further down.

The term deep cross section is often used. The arms are not restricted in their mobility, sensitivity in the upper extremities is also preserved and the respiratory muscles are intact. In the case of tetraplegia, the patient can move neither legs nor arms.

In this case, damage to the cervical spine has occurred. Depending on the location of the damage, the respiratory muscles are also affected. If the nerve fibers are severed at the level of the fourth cervical vertebra or higher, the patient needs artificial respiration.

In addition, a distinction can be made between complete and incomplete paraplegia. In complete paraplegia, the nerve fibers in the spinal cord are completely severed. In an incomplete paraplegia, not all nerve fibers of a spinal cord segment have been severed.

Some of the signals can still be transmitted. In general, the cause of paraplegia is an injury to the spinal cord. In most cases this is caused by an accident (spinal trauma) with fractures of the spine (in the majority of cases this happens in the area of the cervical spine, but in principle this is possible at any height).

As a rule, however, the spinal cord is not cut directly, but only through a fractured vertebral body. For this reason, people suspected of having a fractured vertebral body are also immobilized as far as possible after accidents, for example with the help of a cervical collar that supports the spine. If the fractured vertebra does not sever the spinal cord, but “only” presses on it and squeezes it, the damage depends on the length of time during which this pressure exists.

Some damage, such as paralysis, is reversible in part over a certain period of time. In addition, all diseases that destroy the spinal cord can also cause paraplegia. Some inflammations can damage the spinal cord, especially polio (poliomyelitis).

There is an effective vaccine against this disease (see Vaccination against polio), but due to increasing vaccine fatigue, more cases are being observed again. In the clinical picture of multiple sclerosis (MS), an inflammatory reaction to nerve cells also takes place, but this is not triggered by external pathogens, but is caused by a misregulation by the body itself. This is called autoimmune disease.

A tumor can also cause severe damage to the spinal cord.A herniated disc (between the vertebral bodies are the so-called intervertebral discs, which, when they slip out of their actual position, can exert pressure on the spinal cord) usually only leads to paralysis of individual muscles, but in extreme cases it can also cause paraplegia. Sometimes paraplegia also occurs in the context of vascular disease, namely when arteries are blocked and the spinal cord is no longer supplied with sufficient blood to maintain its function. Complications can always occur during any operation.

Post-operative bleeding and wound infections are the most common general surgical risks. It is important that patients are made aware of any new symptoms at an early stage postoperatively. If new paralysis or sensory disturbances occur after the operation, it is important to act quickly.

Sectional imaging, i.e. a CT or MRI, should be performed to determine the cause of these neurological deficits. Sometimes it is remnants of bone or disc tissue that enter the spinal canal and then exert pressure on the spinal cord. In this case, surgery must be performed again immediately to relieve the nerve fibers.

The spinal cord can also be compressed by post-operative bleeding. If the spinal cord is under pressure, surgery should also be performed again. With early surgical intervention, permanent secondary damage can often be avoided. Overall, the risk of permanent paraplegia after surgery on the cervical spine can be considered very low.