Paraplegia
Paraplegia is a condition characterized by the loss of motor and sensory function in the lower extremities, which can result from spinal cord injuries due to trauma such as vehicle or sporting accidents, falls, or gunshot wounds. It affects a significant number of individuals each year, with incidence rates being notably higher in men and among younger adults. Symptoms can vary in severity, leading to complete or partial paralysis, loss of sensation, urinary retention, and an absence of sweating in the affected areas. The degree of paralysis may depend on whether the spinal injury is complete or incomplete, influencing associated functions like bowel, bladder, and sexual health.
Diagnosis typically involves clinical evaluation, imaging techniques like computed tomography (CT) scans, and laboratory tests to assess overall health. Treatment focuses on stabilizing the spine, decompressing any neurologic structures, and initiating rehabilitation to improve quality of life. Therapeutic strategies may include surgical interventions, drug therapies to manage symptoms, and supportive care to prevent complications. While some individuals may experience recovery of function, the extent of paralysis usually stabilizes within a year post-injury, underscoring the complexity and long-term impact of paraplegia.
Paraplegia
ANATOMY OR SYSTEM AFFECTED: Legs, nervous system, spine
DEFINITION: A motor or sensory loss in the lower extremities, with or without involvement of the abdominal and back muscles
CAUSES: Spinal cord injuries, usually resulting from vehicle or sporting accidents, gunshot wounds, falls
SYMPTOMS: Total or partial paralysis with loss of motion, sensation, and reflexes below lesion; urinary retention; absence of perspiration in paralyzed parts
DURATION: Permanent or temporary
TREATMENTS: Spinal alignment and stabilization, laminectomy, drug therapy (nitrofurantoin, vitamin C, analgesics and narcotics)
Causes and Symptoms
Paraplegia, the loss of motor and function in the lower body, results in that may be complete or incomplete, spastic or flaccid, symmetric or asymmetric, and permanent or temporary. Almost half of the 10,000 to 12,000 spinal cord injuries reported each year result in paraplegia. This condition occurs twice as often in men as in women, and the incidence is highest between ages sixteen and thirty-five. Most injuries result from trauma, especially automobile, motorcycle, and sporting accidents; gunshot and falls also contribute. Less common causes are nontraumatic lesions, such as spina bifida, scoliosis, and chordoma.
In many patients, the onset of total or partial paralysis is immediate, resulting in loss of motion, sensation, and reflexes below the level of the lesion, with urinary retention and absence of perspiration in the paralyzed parts. In some patients, careful questioning and gentle examination are necessary to determine the extent of motor or sensory loss. Spinal cord injuries with motor and sensory loss may result in bowel, bladder, and sexual dysfunctions, depending on the level of the and whether damage to the cord is complete or incomplete. In an incomplete spinal cord injury, perianal sensation, voluntary toe flexion, or control is still present. In a complete spinal cord injury, lack of sensation or voluntary muscle control is apparent and persists for twenty-four hours. Any return of functional muscle power to the injury is unlikely.
Diagnosis requires a clinical history, examination, and computed tomography (CT) scans. A lumbar puncture may rule out blocked cerebrospinal circulation. Laboratory studies include a complete blood count (CBC), prothrombin time, electrolytes, twenty-four-hour urine for clearance, creatinine, and urinalysis. Weekly urine samples for culture and are advisable during the entire period.
Treatment and Therapy
The four goals of treatment for any spinal cord injury are of normal alignment for the spine, early assurance of complete stability of the injured spinal area, decompression of compressed neurologic structures, and early rehabilitation to an active and productive life.
Treatment begins at the scene of the accident by not moving the patient until the and head have been stabilized through strapping the patient to a board. Even after reaching the hospital, the patient is not removed from the board but placed on a stretcher while still strapped to it. Such stabilization helps prevent reversible damage from becoming permanent through additional injury to the neuraxis. Supportive treatment corrects shock and controls local hemorrhage. Insertion of a Foley ensures uninterrupted urine drainage.
Whenever possible, the care of spinal cord injuries emphasizes conservative treatment, such as closed of fractures. However, unstable fractures and fracture dislocations require fusion following reduction, combined with recumbent immobilization until healing occurs. Bone fragments pressing on the spinal cord may require laminectomy (surgical removal of the vertebral arch). Drug therapy may include nitrofurantoin to prevent infection; large doses of vitamin C to enhance utilization of protein and help minimize infection by acidifying the urine; diazepam, baclofen, or dantrolene sodium to relieve spasms from upper motor disorders; and, sparingly, analgesics and to relieve pain. The extent of paralysis cannot be accurately assessed until a year after the spinal cord injury.
Bibliography
Asbury, Arthur K., et al., eds. Diseases of the Nervous System: Clinical Neuroscience and Therapeutic Principles. 3d ed. New York: Cambridge University Press, 2002.
Bromley, Ida. Tetraplegia and Paraplegia: A Guide for Physiotherapists. 6th ed. New York: Churchill Livingstone/Elsevier, 2006.
Fehlings, Michael G. Essentials of Spinal Cord Injury: Basic Research to Clinical Practice. New York: Stuttgart, 2013.
Iansek, Robert, and Meg. E. Morris, eds. Rehabilitation in Movement Disorders. Cambridge: Cambridge University Press, 2013.
Kohnle, Diana. "Paraplegia." Health Library, November 28, 2012.
"Spinal Cord Injury." National Institute of Neurological Disorders and Stroke, 20 Jan. 2023, www.ninds.nih.gov/health-information/disorders/spinal-cord-injury. Accessed 7 Apr. 2024.
Victor, Maurice, and Allan H. Ropper. Adams and Victor’s Principles of Neurology. 9th ed. New York: McGraw-Hill, 2009.
Vithana, K.V.G.S.G., T.A. Asurakkody and D.P. Perera. "Psychological Experiences of Family Carers of People with Spinal Cord Injury Paraplegia: An Explorative Qualitative Study." Policy Press, 15 May 2023, doi.org/10.1332/239788221X16813137336637. Accessed 7 Apr. 2024.