Quadriplegia: Causes, Classification, Types, Symptoms, Diagnosis, Treatment, Complications and Prognosis

Also called quadriplegia, it is the result of a serious spinal cord injury.

In a minute, a person will be fit and active, and in a matter of seconds they may be paralyzed or severely restricted in movement and in need of support for the rest of their lives.

Tetraplegia differs from paraplegia in that the victim suffers a total or partial paralysis from the neck down, affecting all four extremities and the body. It is the result of damage to the spinal cord between C1 and C8.

The spinal cord is about 18 inches long and extends from the base of the brain to near the waist.

Higher motor neurons are found in the bundles of nerve fibers or that make up the spinal cord itself.

The spinal nerves that branch out from the spinal cord at regular intervals in the neck and back contain lower motor neurons.

The spine is divided into four sections, not including the tailbone:

  • Cervical vertebrae (C1-7) located in the neck.
  • Thoracic vertebrae (T1-12), in the upper part of the back (attached to the rib cage).
  • Lumbar vertebrae (L1-5) in the lower back.
  • Sacral vertebrae (S1-5) in the pelvis.

The severity of an injury depends on the part of the spinal cord affected.

The higher the level of injury to the spine, or the closer it is to the brain, the more effect it will have on how the body moves and what can be felt.

Voluntary movement, sensation, and control are generally present with lower-level injuries.

Causes of quadriplegia

This problem arises when the brain or spinal cord is injured or damaged at the C1 to C7 levels.

Spinal cord injury is normally secondary to damage to the vertebrae present in the cervical section of the spine.

Spinal cord injury can lead to partial or total loss of function of all four limbs, that is, the arms and legs.

General causative factors of the condition that occur from damage to the spinal cord include:

  • Trauma, such as a car accident, sports injury, or fall.
  • Diseases, such as polio or transverse myelitis.
  • Congenital disorders, such as multiple sclerosis or muscular dystrophy.

The vertebrae can be dislocated or fractured without damaging the spinal cord, it is even very possible for the neck to be fractured, without the individual suffering from tetraplegia. The spinal cord can also be injured without fracture.

All quadriplegics experience finger dysfunction in one form or another. Therefore, it is not really uncommon to find a quadriplegic individual who has fully functional arms but has difficulty moving the fingers.

Classification of tetraplegia

Spinal cord injuries can be classified into two types:

Tetraplegia

It is the result of injuries to the spinal cord in the cervical (neck) region, with an associated loss of muscle strength in all four extremities.

In general, the sensory and motor nerves are affected, which means that one loses both sensation and control of that part of the body.

This condition is also known as quadriplegia.

The paraplejia

It is the result of injuries to the spinal cord in the thoracic or lumbar areas, resulting in paralysis of the legs and lower body

Complete spinal cord injuries

The spinal cord of a quadriplegic individual can be classified into 3 segments that can be used to classify the injury.

Functional medullary segment

The functional spinal segment has paralyzed muscles. Evaluation of your strength can be done using the muscle scale that rates muscle power on a scale of 0 to 5 in relation to the maximum expected for that muscle.

Matamere

A metamere is made up of many enervated muscles (lower motor neuron). These muscles are atrophic, hypotonic, and do not show spontaneous contractions.

Segmento sublesional

The sublesional segment is located below the metameric segment and has a lower motor neuron that shows intact spinal reflexes but does not have superior cortical control.

Incomplete spinal cord injuries

Incomplete spinal cord injuries can lead to various post-injury presentations. Three main syndromes are described, depending on the exact site and extent of the lesion.

Central cord syndrome

Most of the cord injury lies in the gray matter of the spinal cord, the injury may occasionally continue in the white matter.

Anterior cord syndrome

A lesion that occurs in the anterior horns as well as the anterolateral pathways.

Brown-Séquard syndrome

It affects the cross section of the spinal cord, also known as hemiplegia.

Types of quadriplegia

spastic tetraplegia

Spastic quadriplegia or spastic tetraplegia is a form of spastic diplegia that affects all 4 extremities (legs and arms) rather than just the legs.

It is different from and unrelated to general quadriplegia, in that its central feature is spasticity, whereas quadriplegia is primarily defined by paralysis.

Functional tetraplegia

It is a term used to describe a condition of complete immobility caused by severe physical disability.

Congenital tetraplegia

It refers to cases of quadriplegia caused by congenital factors.

Transient tetraplegia

It occurs when an individual’s cervical spinal cord suffers a temporary but serious injury.

Nerve dysfunction can occur in any of the arms or legs, on one side of the body, or in all four limbs.

Patients may experience pain, numbness, or complete paralysis.

A transient quadriplegia usually takes 15 minutes to resolve, but occasionally it may take longer, taking almost 48 hours.

Symptoms of tetraplegia

Flabby arms and spastic legs are the most common signs of quadriplegia.

While limb impairment is the most common symptom, impaired function is also seen in the torso.

This can lead to a loss of control over the bowel and bladder, digestion, sexual function, breathing, and other autonomic functions.

There is also a loss of sensation experienced in the affected areas, which can manifest as reduced sensation, numbness, or intensely burning neuropathic pain.

Due to their reduced functioning and immobility, tetraplegics are frequently more vulnerable to conditions such as:

  • Osteoporosis.
  • Fractures
  • Ulcers of the ulna.
  • Spasticity
  • Frozen joints.
  • Deep vein thrombosis.
  • Autonomic dysreflexia.
  • Respiratory infections and complications.
  • Cardiovascular disorders

The severity or intensity of the tetraplegic condition depends on the level of spinal cord injury and the degree of injury.

A person with a C1 level injury (highest cervical vertebra located at the base of the skull) will likely lose functionality from the neck down and depend on ventilation.

A person with a C7 injury may lose functionality from the chest down, yet retain the ability to use the hands and arms.

The extent or intensity of the injury is also a vital factor. A total division of the spinal cord can result in a complete loss of functionality down from the vertebra.

A partial division or hematoma of the spinal cord leads to varying degrees of paralysis and mixed functions.

While there is a common misconception regarding quadriplegia that the patient is unable to move their arms, legs, or perform other important functions, this is generally not the case.

Many tetraplegic patients can use their hands and walk, as if they don’t even have a spinal cord injury.

Some of the patients may become wheelchair dependent and still retain some movement and functionality of the arms and fingers, although this depends on the extent of the spinal cord damage.

A common symptom of this condition is that a person may have movement in the extremities, as if they could move their arms and yet not move their hands or have the ability to move their fingers, although not as efficiently as before.

Limbic deficiencies may also not be the same on both sides of the body, affecting the left or right side more strongly.

The location of the spinal cord injury determines the symptoms in such cases.

Diagnosis of tetraplegia

CT scans, MRIs, and X-rays are commonly used to diagnose this condition.

The neurological classification scale for spinal cord injury allows the rating of patients based on the functional deficiencies caused by the injury, and rates patients from class A to class D.

This has significantly influenced therapy and surgical planning.

The neurological classification scale for spinal cord injury is represented as follows:

  • Grade A, complete: sensory or motor function is not preserved in the sacral segments of S4 and S5.
  • Grade B, Incomplete: sensory functioning is preserved without motor functioning below the neurological level; It includes the sacral segments of S4 and S5.
  • Grade C, Incomplete: motor function remains below neurological level; More than 50% of the key muscles below the neurological level have a muscle grade less than 3.
  • Grade D, incomplete: motor function remains below the neurological level; At least 50% of the key muscles below the neurological level have a muscle grade of 3 or higher.
  • Grade E, Normal: sensory and motor functions are normal.

Treatment of tetraplegia

Treatment for the condition consists of curing the spinal cord injury or any other condition that may have caused the problem.

While the spinal cord injury is being treated, the patient is kept immobilized by using special equipment that helps prevent further injury.

Doctors work to stabilize blood pressure, heart rate, and general health.

A doctor might use intubation to make breathing easier. Intubation involves inserting a flexible tube that carries oxygen down a patient’s throat.

Surgery may be required to relieve pressure on the spine from bone fragments or other foreign objects.

A surgical procedure can stabilize the patient’s spine, although injured nerves in the spinal cord cannot be repaired with surgery.

Nerve damage caused by the initial spinal cord injury has a propensity to spread.

Researchers do not fully understand the underlying reason for this trend, although it is believed to be clearly associated with the spread of inflammations as blood circulation is reduced and blood pressure falls.

Methylprednisolone is a powerful corticosteroid that can sometimes be used to prevent the spread of the condition, if given within 8 hours of the actual injury.

However, not all doctors advocate the use of methylprednisolone, as it can cause serious side effects.

Rehabilitation was once used to train patients on how to deal effectively with their obstacles.

Muscle atrophy is prevented by passive physical therapy.

Today, there are many new treatment options available that offer new hope to quadriplegic patients.

These new methods combine old modes of treatment with new technologies to produce encouraging results.

Therapists use a technology known as functional neuromuscular stimulation in which electrodes are used to stimulate the patient’s muscles.

Undamaged peripheral nerves are prompted by functional neuromuscular stimulation, causing the paralyzed muscles to contract.

While undergoing functional neuromuscular stimulation, a person can also ride a bicycle to improve heart and muscle function and prevent muscle atrophy.

A complicated surgical procedure, known as a tendon transfer, can be performed to facilitate greater use of the arms and hands.

A nonessential muscle that has a nerve function is transferred in this process to the arm or shoulder to help restore function.

Complications of tetraplegia

Tetraplegic patients may experience the following complications:

  • Pain.
  • Stinging.
  • Impotence.
  • Blood clots.
  • Pneumonia.
  • Frozen joints.
  • Kidney stones
  • Ulcers of the ulna.
  • Muscle spasms.
  • Renal problems.
  • Deep venous thrombosis.
  • Autonomic dysreflexia.
  • Respiratory complications.
  • Loss of bowel and bladder control.

Forecast

If the diagnosis of cervical spine injury is delayed, it can have serious consequences for the patient.

In nearly 30% of cases where diagnosis has been delayed, cervical spine injury has been found to progress to permanent neurological deficits.

Total paralysis from the neck down can result from high-level cervical injuries.

Tetraplegics of an advanced stage (C4 or higher) tend to require constant care and assistance, while managing various daily activities.

Low-level tetraplegics (C5 to C7) can often live independently.

In cases of cerebral palsy, physical therapy can allow some quadriplegics to learn to stand or walk.

Life expectancy for quadriplegia is normal and includes the remaining years of your life.