What is paraplegia? |

Causes and Symptoms

Paraplegia, the loss of motor and sensory function in the lower body, results in paralysis 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 spinal cord injuries result from trauma, especially automobile, motorcycle, and sporting accidents; gunshot wounds 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 lesion and whether damage to the cord is complete or incomplete. In an incomplete spinal cord injury, perianal sensation, voluntary toe flexion, or sphincter 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 distal to the injury is unlikely.

Diagnosis requires a clinical history, neurologic examination, and computed tomography (CT) scans. A lumbar puncture
may rule out blocked cerebrospinal fluid
circulation. Laboratory studies include a complete blood count (CBC), prothrombin time, electrolytes, twenty-four-hour urine for creatinine clearance, serum creatinine, and urinalysis. Weekly urine samples for culture and sensitivity are advisable during the entire rehabilitation period.

Treatment and Therapy

The four goals of treatment for any spinal cord injury are restoration 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 spine 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 systemic shock and controls local hemorrhage. Insertion of a Foley catheter ensures uninterrupted urine drainage.

Whenever possible, the care of spinal cord injuries emphasizes conservative treatment, such as closed reduction 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 bladder
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 skeletal muscle spasms from upper motor neuron disorders; and, sparingly, analgesics and narcotics 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.

Victor, Maurice, and Allan H. Ropper. Adams and Victor’s Principles of Neurology. 9th ed. New York: McGraw-Hill, 2009.