Brief overview
- What is paraplegia? Partial or complete severing of the nerves in the spinal cord
- Treatment: Acute therapy, surgery, medication, rehabilitation
- Course of disease and prognosis: Individual course, prognosis depends on extent and location of damage
- Symptoms: Depending on extent and location of spinal cord damage: paralysis of legs and arms as well as trunk, loss of bladder and bowel control, disruption of sexual function
- Diagnostics: course of accident, typical symptoms such as paralysis of legs (and arms) and loss of sensation, imaging (X-ray, CT, MRI), examination of blood and spinal fluid.
- Prevention: general safety measures to avoid accidents, treatment of the underlying disease
What is paraplegia?
Definition
In complete spinal cord syndrome, affected individuals are completely paralyzed below the level of injury; in incomplete spinal cord syndrome, residual functions are preserved.
What is the spinal cord?
The spine consists of four sections:
- Cervical spine (HWS): 7 vertebrae (C1 to C7)
- Thoracic spine (BWS): 12 vertebrae (Th1 to Th12)
- Lumbar spine (LWS): 5 vertebrae (L1 to L5)
- Sacral spine (SWS): sacrum (Os sacrum) and coccyx (Os coccygi)
If this nerve connection in the spinal cord is disturbed or interrupted, the transmission of these signals in both directions fails. Depending on the level of the spinal cord injury, paralysis of the legs (and arms) occurs, as well as functional disturbances in various areas of the body – most commonly problems with urination or defecation and sexual dysfunction.
What is paralyzed?
Paraplegia leads to significant failures of various bodily functions in affected individuals. Depending on the case, the following nervous systems are affected, either alone or in combination:
- Motor nerves: necessary for the conscious movement of arms and legs
- Vegetative nerves: emptying of bowels and bladder, sweating, cardiovascular control, respiratory function, sexuality
- Sensory nerves: sensation of touch and pain
Classification according to the severity of the spinal cord injury
Complete paraplegia (plegia, paralysis): In complete paraplegia, the nerves are completely severed at a specific location. Depending on the location of the damage, the arms, legs and trunk are completely paralyzed, and muscle strength and sensation are completely absent. Body functions such as bowel and bladder emptying and sexual function are severely impaired.
Classification according to the level of injury
Paraplegia/paraparesis: If the spinal cord damage is in the thoracic or lumbar spine – below the first thoracic vertebra – the legs and parts of the trunk are paralyzed. The arms are not affected.
Paraplegia has considerable effects on quite a few bodily functions, but never impairs mental abilities!
Frequency
Men are significantly more likely to suffer from traumatic paraplegia than women, at around 80 percent, and the average age is 40.
Is paraplegia curable?
There are now good opportunities to improve the situation of affected people through targeted therapies. The goal of any treatment is holistic rehabilitation, which should enable those affected to lead as self-determined a life as possible.
Treatment in the acute phase
Surgery
In many patients, surgery is necessary after the accident. It serves to relieve the spinal cord. This is the case, for example, with vertebral fractures or herniated discs. Here, the surgeon tries to remove any bone splinters that may be present or to stabilize the spinal column.
Medication
Rehabilitation
The primary goal of rehabilitation is for the patient to lead a largely self-determined life after hospitalization and to avoid complications. Since paraplegia affects many different areas of life, the patient is usually supported by an interdisciplinary team of doctors, nurses, physiotherapists, occupational therapists and psychotherapists in finding their way back into everyday life step by step.
Every paraplegic receives therapy that is individually adapted to his or her needs. Talk openly with your doctor or therapist about your ideas and fears!
In rehabilitation, affected persons gradually learn to live with their disability. Rehabilitation includes the following measures:
- Physiotherapy and wheelchair training
- In occupational therapy, patients learn new movement patterns with the aim of performing everyday activities such as dressing or preparing meals independently again.
- Psychotherapy teaches strategies for coping better with the new situation.
- Speech therapy exercises help with speech and swallowing disorders. If the diaphragm is paralyzed, those affected learn techniques that enable them to breathe independently for several hours during the day.
Effects on life
Disease progression
Complete severing of the nerves leaves the extremities (legs, arms) paralyzed, which cannot be cured. Depending on whether the injury is above or below the first thoracic vertebra, doctors speak of tetraplegia/tetraparesis (paralysis of all four extremities including the trunk) or paraplegia (paralysis of the legs as well as parts of the trunk).
If the paralysis was triggered by non-traumatic causes, it may be possible to correct it. This is the case, for example, with inflammations of the spinal cord. If nerves are still intact, they may take over the tasks of the lost nerves. In this case, doctors speak of “recompensation”.
Prognosis
Symptoms
The symptoms that occur depend on the extent and type of spinal cord injury. There are different nerve pathways in the spinal cord: sensory nerves for sensations such as heat, cold, touch or pain, and motor nerves that control movement. Depending on which pathway is affected, the symptoms also differ.
Symptoms in the acute phase (spinal shock)
In the phase of spinal shock, patients therefore require intensive medical care to maintain vital bodily functions. Only after the shock has subsided is it possible to estimate the actual extent of permanent damage.
Characteristics of spinal shock:
- Complete flaccid paralysis of muscles below the level of injury.
- No sensation of touch or pain below the level of injury
- Absence of reflexes below the level of injury
- Intestinal obstruction due to paralyzed intestinal muscles
- Respiratory failure due to diaphragmatic paralysis with damage above the fourth cervical vertebrae
- Circulatory weakness
- Low body temperature
- Kidney disorders
Symptoms of complete paraplegia
Symptoms of incomplete paraplegia
Bowel and bladder emptying disorder
Nearly all people with paraplegia develop bowel emptying and bladder emptying disorders. Bowel emptying disorders are:
- Constipation
- Diarrhea
- Bowel obstruction
- Because the sphincter muscle in the rectum is also affected, affected individuals have little or no control over bowel movements.
Bladder emptying disorders:
- Affected persons lose urine uncontrollably.
Sexual function disorder
What are the possible complications of paraplegia?
The muscle paralysis or sensory disturbances have long-term consequences that affect the lives of many paraplegics.
- Urinary tract: urge incontinence, recurrent bladder infections, kidney dysfunction
- Gastrointestinal tract: constipation, diarrhea, fecal incontinence, bowel obstruction.
- Vessels: risk of vascular occlusion (especially deep vein thrombosis) is increased
- Chronic pain (neuropathic pain) manifests as constant burning, tingling, or electrifying sensations.
- Impairment of sexual function: reduced lubrication of the vagina, restricted erectile function in men.
- Ulcers in pressure-loaded areas (decubitus) such as the ischium, sacrum and coccyx, the thigh bone (greater trochanter) or the heels
- Bone loss (osteoporosis) in the paralyzed part of the body
- Disturbance of breathing with congestion of secretions, pneumonia or collapse of the lungs in case of injury above the fourth thoracic vertebra (paralysis of the diaphragm)
What are the causes of paraplegia?
Accidents
In about half of the cases, trauma is the cause of paraplegia. In this case, the spinal cord is damaged by direct, sometimes massive force. Examples include traffic accidents, falls, sports injuries or swimming accidents.
Non-traumatic damage
- Multiple Sclerosis
- Herniated disc
- Vertebral body fracture (vertebral fracture)
- Spinal cord infarction (spinal ischemia)
- Spinal cord inflammation caused by certain viruses or bacteria (infectious myelitis), in some cases autoimmune-related inflammation
- Tumors in the spinal cord, usually metastases from prostate or breast cancer
- As a result of radiation therapy (radiation myelopathy)
- Extremely rarely, paraplegia occurs as a result of the removal of cerebrospinal fluid (lumbar puncture) or spinal anesthesia (anesthesia for procedures on the lower half of the body such as Cesarean section, hip replacement surgery).
What does the doctor do?
Medical history
In the case of spinal cord injuries due to a fall or accident, the description of what happened provides the physician with the first indications of a possible paraplegia.
Clinical neurological examination
The physician tests whether the patient can move or feel stimuli, for example, with a needle. He also checks reflexes as well as respiratory, bladder, bowel and heart function.
Imaging procedures
Examination of blood and cerebrospinal fluid
Examinations of the blood and the fluid surrounding the bone marrow (cerebrospinal fluid) provide information about a possible infection with bacteria or viruses.
Decision on further procedure
Based on these preliminary examinations, the physician decides what further steps are necessary. A final diagnosis on the actual extent of the paralysis is only possible once the spinal shock has subsided.
Prevention
About half of all spinal cord injuries are consequences of accidents or falls. These primarily include traffic accidents, recreational accidents and accidents at work.
Tips to prevent injuries:
- Do not jump headfirst into unfamiliar waters.
- Take safety precautions in the workplace (especially when working at heights, such as a roofer).
- Drive a car or motorcycle with caution.
- Fix ladders, do not stack furniture on top of each other as a substitute for ladders.
If the paraplegia is the result of another disease, prevention is only possible to a limited extent – not at all in the case of congenital diseases.
