Index
Also called quadriplegia, it results from a severe 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 need 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 results from 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 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) are 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 effective 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 usually is 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: 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 possible for the neck to be cracked without the individual suffering from tetraplegia. The spinal cord can also be injured without fracture.
All people with quadriplegia experience finger dysfunction in one form or another. Therefore, it is not 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 results from 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, meaning one loses both sensation and control of that part of the body.
This condition is also known as quadriplegia.
The paraplegia
It results from 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 three 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 about the maximum expected for that muscle.
Metamere
A metamere comprises many enervated muscles (lower motor neurons). These muscles are atrophic, hypotonic, and do not show spontaneous contractions.
Segmento sublesional
The sublesional segment is located below the metameric element 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 primary syndromes are described, depending on the exact size and extent of the lesion.
Central cord syndrome
Most cord injury lies in the gray matter of the spinal cord; the damage may occasionally continue in the white case.
Anterior cord syndrome
A lesion that occurs in the anterior horns and 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 four 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 genetic factors.
Transient tetraplegia
It occurs when an individual’s cervical spinal cord suffers a temporary but severe injury.
Nerve dysfunction can occur in any arms or legs, on one side of the body, or in all four limbs.
Patients may experience pain, numbness, or complete paralysis.
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, manifesting as reduced sensation, numbness, or intensely burning neuropathic pain.
Due to their reduced functioning and immobility, people with tetraplegia 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 damage.
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 of the 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 cannot move their arms, legs, or perform other essential 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 moved in the extremities as if they could move their arms and yet not move their hands or can 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 patients to rate patients based on the functional deficiencies caused by the damage 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 held without motor functioning below the neurological level; It includes the sacral details 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 disease 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 damage.
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 tends to spread.
Researchers do not fully understand the underlying reason for this trend. However, it is believed to be associated with the spread of inflammations as blood circulation is reduced and blood pressure falls.
Methylprednisolone is a potent 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 using methylprednisolone, as it can cause serious side effects.
Rehabilitation was once used to train patients to deal effectively with their obstacles.
Muscle atrophy is prevented by passive physical therapy.
Today, many new treatment options are 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 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.
An extrinsic 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 severe consequences for the patient.
In nearly 30% of cases where the diagnosis has been delayed, cervical spine injury has progressed 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) require constant care and assistance while managing daily activities.
Low-level tetraplegics (C5 to C7) can often live independently.
In cerebral palsy cases, physical therapy can allow some people with quadriplegia to learn to stand or walk.
