It is an impairment in the motor or sensory function of the lower extremities. The word comes from the ionic Greek παραπληγίη “half stroke.”
It is usually caused by a spinal cord injury or a congenital condition that affects the spinal canal’s neural elements (brain).
The spinal canal area affected by paraplegia is the thoracic, lumbar, or sacral region. Common victims of this impairment are veterans or members of the military.
Life expectancy for people with paraplegia is shorter than usual, but it has continued to increase.
Paraplegia often affects young people. The average age of those newly affected is 27. Paralysis is one of the worst things that affect your health than anyone can imagine.
Mortality rates are significantly higher in the first few years after injury than in later years. This is especially true as the severity of the injury increases.
Spastic paraplegia is a form of paraplegia defined by the spasticity of the affected muscles rather than flaccid paralysis. The American Spinal Cord Injury Association rates the severity of spinal cord injury.
The American Spinal Cord Injury Association A: is the complete loss of sensory function and motor skills below the injury. No sensory or motor function is preserved in sacral segments S4-S5.
The American Spinal Cord Injury Association B: Has some sensory function below the injury but has no motor function.
The American Spinal Injury Association C: Some motor function is below the level of injury, but half of the muscles cannot move against gravity.
The American Spinal Cord Injury Association D: More than half of the muscles below the level of injury can move against gravity.
The American Spinal Injury Association E is the restoration of all neurological functions.
Symptoms of paraplegia
Immediately after spinal cord injury, loss of movement, sensation, and reflexes may occur below the level of the spinal cord injury. The first signs are numbness and immobility in the legs, accompanied by extreme back pain.
Sexual dysfunction and bladder and bowel control loss can also occur, depending on where the spinal cord injury occurred and whether the spinal cord was cut wholly or partially.
The extent of the paralysis depends on the spinal cord level where the damage occurs. For example, damage to the lower area of the umbilical cord can result in paralysis of the legs.
While more significant cord damage causes a possible loss of control over the muscles of the bladder and rectum or, if it occurs, even more, it can result in paralysis of all four limbs and loss of control over the muscles involved in breathing.
Due to decreased or loss of sensation or function in the lower extremities, paraplegia can contribute to several medical complications, including pressure (decubitus) ulcers, thrombosis, and pneumonia.
As paraplegia is often the result of traumatic injury to the spinal cord tissue and the resulting inflammation, other nerve-related complications can occur. Cases of chronic nerve pain in the areas surrounding the point of damage are not uncommon.
It is speculated that the “phantom pain” experienced by people who have paralysis could directly result from these collateral nerve injuries misinterpreted by the brain.
Once the accident victim has been rescued (which should only be done by qualified experts), an operation is performed to repair the cut in the dorsal vertebra.
What parts of the body are affected by paraplegia?
Depending on where your back was injured, paralysis can affect different body parts—paraplegia results from an injury to the spine at the thoracic or lumbar vertebra level. For most people with paraplegia, the legs and details of the torso are paralyzed.
Paralysis means that the muscles in the legs, stomach, back, and possibly the chest no longer work. The affected person can no longer walk or stand.
Paralysis in the legs is often spastic, which means that the muscles sometimes contract together. Many people with paraplegia have a hard time sitting up straight.
Does it also cause loss of sensation?
The musculature is not the only thing lost at the moment of paralysis, the sensation of feeling. People with paraplegia have no sense of contact or position in the paralyzed parts of their bodies.
They do not feel pain or temperature in the affected areas. Because the skin can no longer perceive injuries, those affected are at risk of burns or injury from pressure sores.
Are the excretory organs also affected?
One of the hardest things for people with paraplegia to endure is excretory organ disorders. Both the bladder and intestines no longer work properly.
Fifty years ago, these excretory organ disorders cost most patients their lives after only a few years.
Thanks to medical advances, these problems are no longer life-threatening (such as self-catheterization). However, most patients find them socially limiting.
How does paraplegia affect sexuality?
Men with paraplegia have trouble getting a full erection. Both men and women may find that their ability to orgasm is impaired.
Despite this, many people describe their sex life as satisfying. Men with paraplegia can have children. Women can become pregnant spontaneously. In most cases, both pregnancy and delivery usually proceed.
Paraplegia is predominantly the result of a spinal cord injury. The spinal cord is a chain of nerves the width of your little finger in the bony spinal canal.
The damage is usually caused by accident, other trauma, or, more rarely, by a disease, such as a tumor. The most common accidents include car accidents and falls in people over 65.
Spinal injuries are not always immediately apparent, and numbness or paralysis may be delayed or immediate.
Additional injury can occur from the resulting swelling and bleeding. For this reason, medical attention must be sought immediately, as the time frame is critical for optimal recovery and evaluation.
Diseases that cause paraplegia or quadriplegia include spinal tuberculosis, syphilis, spinal tumors, multiple sclerosis, and polio.
Sometimes when the disease is treated and cured, the paralysis goes away, but usually, the nerve damage is irreparable, and the paralysis is permanent.
Paraplegia due to spinal deformity
Paraplegia is not an uncommon complication of spinal deformities in type 1 neurofibromatosis.
Neurological involvement may be related to spinal deformity, costovertebral complex instability causing direct protrusion of a rib into the spinal cord, vertebral angulation, tumor, or dural ectasia.
The paraplegia that occurs in a younger age group is often caused by deformity of the spine, and paraplegia in the older age group is often the result of a tumor.
Paraplegia after corrective surgery is often due to compression exerted on the spinal cord by an unrecognized neurofibroma or by a rib in the intraspinal space.
Rarely is the patient reported to have paraparesis due to rib displacement. This can have an insidious beginning, or it can occur after trauma.
Bone dysplasia increased intervertebral foraminal and rotation of the vertebral bodies can all mechanically contribute to allowing the heads of the ribs to move in the canal.
In the spinal deformity group, kyphosis is the most common cause of paraplegia. Increased kyphosis leads to excessive axial stress on the spinal cord, especially the posterior dura, which compresses the spinal cord against the anterior vertebral body.
Paraplegia is rare in a pure scoliotic curve; if present, a study for intraspinal pathology should be performed.
If paraplegia is present, MRI or CT scan with myelography is appropriate to find the cause of the paraplegia. With a severe deformity, the interpretation of these images can be confusing, however, and often inconclusive.
Root symptoms due to vertebral arteriovenous fistulas have also been reported. The most common form is a dural arteriovenous fistula located in the sleeve of the thoracolumbar nerve root.
Kähärä and colleagues recently reported a post-traumatic arteriovenous fistula causing radicular symptoms due to a mass effect of the dilated epidural venous space.
Before surgery, the source of paraparesis, paraplegia, or radiculopathy must be thoroughly investigated to prepare the surgeon to perform the necessary surgery and have the appropriate assistance available.
Loss of function
The extent of function lost due to paraplegia corresponds to the size of damage to the spinal cord and the affected area. The areas of the spinal cord that produce paraplegia are the thoracic, lumbar, or sacral regions.
An injury to the upper chest (T1 to T8), roughly adjacent to the chest, often results in poor trunk control. This can include impaired breathing.
Damage to the lower chest (T9 to T12) allows for good trunk function and posture. Lumbar and sacral damage results in poor flexor and hip function.
Treatment for paraplegia
The treatment of paraplegia and tetraplegia aims to help compensate for paralysis using mechanical devices and psychological and physical therapy.
People with paraplegia can vary in their level of disability, requiring that treatments vary from case to case. From the point of view of rehabilitation, the most crucial factor is to obtain the most excellent possible functionality and independence.
Physical therapists spend many hours working on strength, range of motion/stretching, and transfer skills within a rehab setting.
Wheelchair mobility is also an important skill to learn. Most paraplegics will rely on a wheelchair for transportation. Therefore, it is essential to teach them the basic skills to gain independence.
An individual with complete paraplegia may have a total loss of sensory and motor function. Activities of Daily Living (ADL) can be pretty challenging at first for those with a spinal cord injury (SCI).
With the help of physical and occupational therapists, people with spinal cord injury can learn new skills and adapt old ones to maximize independence, often living independently within the community.
Physical therapy and various assistive technologies, such as a standing frame and self-observation, and attentive care, can help prevent the future and mitigate existing complications.
Many use catheters or bowel control programs (often with suppositories, enemas, or digital bowel stimulation) to address impotence and urinary and fecal incontinence issues.
Depending on their injury, patients will need to spend several weeks in a particular clinic or hospital until the back fracture is repaired. After this, patients must be remobilized.
In a rehabilitation program that generally lasts for several months, patients with paraplegia gradually learn to cope with the consequences of their disability.
After rehabilitation, people with paraplegia have a good chance of resuming their everyday lives without outside help.
If a person is suspected of having a back or neck injury, they should not be moved from their position and remain still, as complications, and permanent paralysis can result. It is recommended to contact emergency medical assistance.
Spinal cord regeneration
Olfactory cells (OECs) have been successfully transplanted into the spinal cord of a Polish man named Darek Fidyka, the victim of a stabbing attack that left him paraplegic in 2010.
In 2014, he underwent pioneering Fidyka spinal surgery that uses nerve grafts from the ankle to ‘bridge the gap’ in his severed spinal cord and ensheathing olfactory cells to stimulate the spinal cord cells.
The surgery was performed in Poland in collaboration with Prof. Geoff Raisman, chair of neuronal regeneration at the Institute of Neurology at University College London, and his research team.
The olfactory cells were taken from the patient’s olfactory bulbs in their brain and then grown in the laboratory; these cells were injected above and below the affected spinal tissue.
Fidyka regained sensory and motor function in her lower limbs, notably on the side of the transplanted olfactory cells. Fidyka first noticed success three months after the procedure, when her left thigh began to gain muscle mass.
MRI scans suggest that the gap in your spinal cord has closed. He is believed to be the first person to regain sensory function from a complete rupture of the spinal nerves.
Can paraplegia be cured?
As of yet, there is no cure. Paralysis is irreversible, as damaged nerve cells do not regenerate.
What is the difference between paraplegia and quadriplegia?
Paraplegia is an alteration in the motor or sensory function of the lower extremities that affects and limits a person’s use of their legs; Quadriplegia (tetraplegia) is similar to paraplegia, except that it involves both the use of a person’s upper and lower extremities.
Paraplegia is often the result of a spinal cord injury or a congenital condition such as spina bifida, which affects the neural elements of the spinal canal.
It is usually caused by a severe accident. That is why so many young people are affected by this blow of fate. But thanks to intensive rehabilitation and many supports, people with paraplegia can live independently in society despite their disability.
If four limbs are affected by paralysis, tetraplegia or quadriplegia is the correct term. If only one limb is involved, the right time is monoplegia.
The term ” back fracture ” is not a good description of a spinal cord injury, as the damage is to the cord itself and not to the bony prominences that make up the spinal column.
Individuals with incomplete tetraplegia may have mild changes in their arms and legs that are hardly noticeable. However, such individuals will have different levels of impairments with sensation, strength, mobility, and reflexes.
A complete quadriplegic cannot move his arms or legs at all. There are many variations of arm or leg impairments.
Approximately 11,000 spinal cord injuries reported each year in the United States involve paraplegia. Such events occur due to automobile and motorcycle accidents, sports accidents, falls, and gunshot wounds.
Since 2005, car accidents account for 42.1% of reported spinal cord injury cases. The next most common cause of spinal cord injury falls, followed by acts of violence (primarily gunshot wounds) and recreational sports activities.
The annual incidence of spinal cord injury (SCI), not including those who die at the accident scene, is estimated to be approximately 40 cases per million population in the United States, or about 12,000 new cases every year.
People with a spinal cord injury are two to five times more likely to die prematurely than people without a spinal cord injury, with worse survival rates in low- and middle-income countries.
Mortality rates are significantly higher in the first year after injury than in subsequent years, particularly for seriously injured people.
The number of people in the United States alive in 2008 with spinal cord injuries has been estimated at approximately 259,000 people, from 229,000 to 306,000 people.
In the last 15 years, the percentage of people with incomplete quadriplegia has increased slightly, while complete paraplegia has decreased somewhat.
From 1973 to 1979, the average age of injury was 28.7 years, with most injuries occurring between 16 and 30.
However, as the median age of the general United States population has increased by approximately eight years since the mid-1970s, the median age at injury has also steadily increased over time. Since 2005, the average age at injury has been 40.2 years.
80.9% of spinal cord injuries reported to the national database have occurred among men.
Violence caused 13.3% of spinal cord injuries before 1980, peaking between 1990 and 1999 at 24.8% before declining to just 15.1% since 2005.
The most frequent neurological category at the discharge of the persons reported in the database is incomplete tetraplegia (30.1%), followed by complete paraplegia (25.6%), and complete tetraplegia (20.4%), and incomplete paraplegia (18,5%).
Spinal cord injury is associated with lower school enrollment rates and economic participation and carries significant individual and societal costs.