The paraplegic syndrome

definition

With a paraplegia or paraplegia (med. Paraplegia, transverse syndrome) one understands damage to the spinal cord and the resulting symptoms. A distinction is made between a complete paraplegic syndrome, in which the spinal cord is completely severed, and an incomplete paraplegic syndrome, in which the spinal cord is only partially damaged.

The symptoms of paraplegia depend on the amount of damage to the spinal cord.

The possible causes

The spinal cord runs within the spine and, together with the brain, forms the central nervous system (CNS). The spinal cord consists of nerve tracts that serve to convey motor and sensitive information between the brain and the muscles, the skin and the internal organs. Motor pathways are used to move the muscles, whereas sensitive nerve pathways enable the perception of sensations such as pain, temperature sensation and touch.

In most cases (approx. 70%) the causes of a paraplegic syndrome are injuries to the spinal cord caused by accidents, e.g. after motorcycle or car accidents. Blunt external force can lead to vertebral fractures and crushing or compression of the spinal cord.

Other causes of paraplegia are circulatory disorders in the spinal cord, inflammation, herniated discs, infections or tumors. A stroke in the spinal cord leads to a lack of oxygen (med. spinal ischemia), i.e. due to a blockage in the blood vessels, the spinal cord can no longer be adequately supplied and is damaged. In severe herniated discs, the leaked disc nucleus may pinch the spinal cord or nerve roots and thus damage them. A paraplegic syndrome is often caused by tumors that either originate directly from the nerve tissue in the spinal cord or metastasize from other organs into the spine. The mass causes compression and injury to the spinal cord.

Find out more about the topic here: Paraplegia.

The forms of the transverse syndrome

The incomplete paraplegic syndrome

In the case of incomplete paraplegic syndrome, the spinal cord is not completely severed or damaged. This preserves the function of individual spinal cord tracts and enables at least partial stimulus transmission. The symptoms depend on the height of the lesion. However, the residual functions in motor skills and sensitivity are retained even below the damage.

Incomplete paraplegia can affect either the arms or legs (med. Paraparesis) or all extremities (med. Tetraparesis) affect. Spinal cord compressions from trauma, tumors, or herniated discs are the main causes of incomplete paraplegic syndrome.

Signs of paralysis in the leg? Read more about this here.

The complete paraplegic syndrome

With a complete paraplegic syndrome, the entire cross-section of the spinal cord is damaged, with all nerves being destroyed. Immediately after the traumatic injury, there is initially a spinal shock. This is a temporary condition in which all motor and neurological functions below the lesion fail completely. The extremities are paralyzed flaccid.

After a few weeks, the flaccid paralysis turns into a spastic paralysis, in which the tension of the muscles is abnormally increased and the muscles become permanently tense. In addition, in the complete paraplegic syndrome, there is a loss of sensitivity below the level of the lesion and pathological reflexes (e.g. Babinski reflex), i.e. reflexes that do not occur in healthy individuals. Bladder and bowel problems can also occur.

Find out more about the topic here: Spasticity.

The accompanying symptoms

The accompanying symptoms of paraplegia depend primarily on the level of damage to the spinal cord. Below the injury, the functions that are controlled by the affected part of the spinal cord are disrupted. The most common symptoms are paralysis and loss of sensitivity.

In most cases, the damage occurs in the lower area of ​​the spinal cord and leads to a loss of function of the skeletal muscles. The result is paralysis of the lower extremities, i.e. the legs. An isolated paralysis of the lower extremity is called Paraparesis, whereas the simultaneous paralysis of arms and legs as Tetraparesis referred to as.
In addition, there are sensory disorders (med. Sensory disturbances): the patients suffer from an altered or absent pain and temperature sensation as well as a loss of tactile sensation and the sense of touch.

If the damage is in the upper part of the neck, paralysis of the diaphragm can occur, a life-threatening situation in which the patient can no longer breathe independently.
Another symptom of paraplegia is the appearance of pathological reflexes, e.g. the Babinski reflex. This is a reflex of the sole of the foot, in which stroking the sole causes the big toe to stretch and the other toes to flex.
Many people who have suffered spinal cord injuries unfortunately also have bladder and rectal disorders. Depending on the height of the lesion, circulatory problems often occur as the control of blood pressure by the autonomic nervous system is disturbed.

A paraplegic syndrome and the accompanying symptoms represent a strong psychological burden for those affected, which is why many patients also develop depressive moods and depression.

Read more about the topic here: Symptoms of paraplegia.

Bladder and rectum disorders

Injury to the spinal cord can disrupt the control of the bladder and rectum. Patients are unable to empty their bladder and bowel or cannot empty them completely. Due to the failure of the sphincter muscles and the pelvic floor muscles, paraplegia leads to an involuntary discharge of urine and stool. Incontinence). Mixed forms between incontinence and voiding disorders are also possible.

During rehabilitation treatment, sufferers learn to deal with the disorder and take certain measures that make life with the bladder and rectum disorder easier. These include e.g. To influence the bowel function positively through nutrition and relaxation exercises or to empty the bladder independently with disposable catheters.

Find out all about the topic here: Incontinence.

The diagnosis

If a spinal cord injury is suspected, the patient must be immediately admitted to hospital. There, doctors make the diagnosis based on the medical history, which is often linked to a previous accident or back injury.

The affected person shows signs of paralysis and pathological reflexes. The doctor can determine the height of the lesion through neurological examinations and with the help of so-called identification muscles.Computed tomography (CT) shows fractures and injuries to the spine, whereas the spinal cord itself can be better assessed using magnetic resonance imaging (MRI).

The treatment

In the case of recent paraplegia, the main cause is usually an accident. Treat patients with suspected spinal cord damage as absolute emergencies. If the person is unconscious, they must be ventilated to keep the circulation stable. Until first aid has arrived, it is important to move the victim as little as possible, otherwise the spinal cord could be further damaged. The emergency doctor positions the patient with a splint and ensures that the vital functions (breathing and circulation) are maintained.
In the hospital, the injured spine is treated surgically or conservatively with positioning splints and the patient is then immobilized. Intensive care monitoring is carried out throughout the hospital stay to minimize the risk of complications.

The long-term treatment of paraplegic syndrome is carried out with the aim of actively supporting the remaining possibilities of movement and strengthening movement sequences. There are special facilities that specialize in the treatment of people with paraplegic syndrome. The patient is rehabilitated with physiotherapy, occupational therapy and the use of positioning rails. Paraplegic patients are often dependent on a wheelchair.
An important goal of the follow-up treatment is the reintegration of the person concerned into his social and - if possible - professional life. Since the illness is a strong psychological burden for the patient, a psychological stabilization is necessary, which takes place through intensive psychological or psychotherapeutic care. Many patients take part in self-help groups.

Many new treatment approaches are currently being investigated in order to cure people with paraplegia. Animal experiments have shown that the damaged nerves in the spinal cord can be renewed by the administration of stem cells.
Another approach is the administration of Cordaneurin, a drug that stimulates the regeneration of nerve cells and has already shown initial success in preclinical studies. These results give hope that the paraplegia, which was previously considered incurable, can be treated successfully in the near future.

The occupational therapy

Occupational therapy strengthens residual functions and helps the patient to integrate into everyday life. Trained occupational therapists help those affected to relearn everyday tasks and movement sequences, thereby reducing the need for care.

Therapy strengthens the movement sequences, avoids bad posture and optimizes the patient's handling of the wheelchair (e.g. by training in independent transfer out of the wheelchair and back in again). This can significantly improve the physical condition of the patient and those affected have the opportunity to lead a largely self-determined and independent life.

Find out more about the topic here: Occupational therapy.

The care

Paraplegic syndrome requires lifelong follow-up care for the patient. Caring for an acutely paraplegic patient includes, above all, treating the symptoms (e.g. bladder and rectal disorders), helping with activities of daily life and frequent repositioning to avoid bedsores (med. Pressure ulcer) avoid the patient. At the beginning of the illness, most patients are not only physically but also mentally badly battered and feel overwhelmed by the situation. Psychological support is important here so that the patient does not become depressed or have unrealistic hopes.

Due to the injury to the spinal cord and the associated symptoms, patients have problems coping with everyday life. Usually, those affected are assigned a care level and receive care allowance, which can be applied for from the insurance company. If a paraplegic syndrome is present, the person concerned is considered severely disabled and has the right to a severely disabled person's pass and the associated advantages.

The duration

The paraplegic syndrome is not yet curable. In rare cases there is spontaneous healing. Usually, however, the patients bear the consequences of spinal cord damage for a lifetime and are dependent on wheelchairs.

Prognosis

Paraplegia shows a poor prognosis. In many cases an incomplete paraplegic syndrome turns into a complete one. In some cases, partial remission is possible if the motor paralysis subsides within the first few days.

Nerve cells can no longer divide and remain damaged forever after an injury, which means that paraplegia is considered incurable. In recent years, however, there have been promising studies with stem cells and new drugs that hope that the disease will one day be cured. So far, however, none of these methods has led to the cure of paraplegia.

Read more about the topic here: Cure for paraplegia.