Paraplegia

Synonyms in a broader sense

Paraplegic syndrome, paraplegic lesion, transverse syndrome

Medical: Paraplegia, (spinales)

English: paraplegia, transverse lesion

definition

The Paraplegia is not a disease but a combination of symptoms that occur as a result of an interruption in the nerve conduction of the spinal cord.

Together with the brain, the spinal cord forms the central nervous system (CNS). It extends from above the first cervical vertebra to about the second lumbar vertebra and is protected in a bony canal, the spinal canal, which is located within the spine. On the one hand, the spinal cord forwards commands from the brain to the muscles, on the other hand, it also carries information about touch, pain or position of the limbs from the body back to the brain.
It also houses nerves that are responsible for controlling internal organs, so it also controls processes that are largely unconscious, such as digestion or the heart rate (autonomic nervous system). A severing of the spinal cord through an injury leads to failure of the above-mentioned functions below this, i.e. not only to paralysis (failure of motor function), but also to damage to the sensitive and vegetative components, which is why the word paraplegic syndrome actually describes this condition more accurately than the Term paraplegia.

Find out more about the topic here: Paraplegic syndrome.

Epidemiology

In Germany 1,000 to 1,500 new people are added by one every year Paraplegia affected, with 80% occurring in men. The most frequent root cause (about 70%) are accidents, of which by far the most common type are car accidents.

Forms of paraplegia

A distinction is made between different forms of paraplegia. One differentiator is on which Spinal cord height the violation occurred. One speaks of one Paraplegia if there is a severing of the spinal cord in the Thoracic vertebrae or below comes. Often the term deep cross-section used. The arms are not restricted in their mobility, the sensitivity of the upper extremities is preserved and the respiratory muscles are intact.
At a quadriplegia can the patient neither legs nor arms move. Here there is damage in the area of ​​the Cervical spine came. Depending on the location of the damage, the Respiratory muscles impaired. Are the nerve fibers at the level of the fourth cervical vertebra or above being severed is one thing for the patient artificial respiration necessary.

In addition, you can choose between a complete and one incomplete paraplegia distinguish. With a complete paraplegia there is a complete severing the nerve fibers in the spinal cord. If you have incomplete paraplegia not all nerve fibers a segment of the spinal cord has been severed. Some of the signals can still be passed on.

causes

Generally the cause is one Paraplegia in a violation of the Backmarks. Mostly this happens through an accident (spinal trauma) with fractures of the Spine (In the majority of cases this happens in the area of ​​the cervical spine, but in principle this is possible at any height). As a rule, however, the spinal cord is not severed directly, but only through a broken one Vertebral bodies. Because of this, people who are suspected of having a Vertebral fracture is made immobile as much as possible after accidents, for example with the help of a neck brace that supports the spine. If the broken vertebrae Spinal cord not cut through, but “only” presses on it and squeezes it in, the damage depends on the period of time during which this pressure exists. Some damage, such as paralysis, is partially reversible over a certain period of time.

In addition, any diseases that destroy the spinal cord can also one Paraplegia trigger. Some Inflammation can damage the spinal cord, especially the poliomyelitis (poliomyelitis). There is an effective vaccine against this disease (see Vaccination against polio), but due to increasing vaccination fatigue, more cases are observed again. With the clinical picture of Multiple sclerosis (MS) also finds an inflammatory reaction to it Neurons instead, which is not triggered by external pathogens, but arises due to a dysregulation by the body itself. This is known as Autoimmune disease.

Also a space claim by one tumor can seriously damage the spinal cord. A disc prolapse (between the vertebral bodies are the so-called Band washerswhich, if they slip out of their actual position, can exert pressure on the spinal cord) usually only paralyzes individual muscles, but in extreme cases can also trigger paraplegia. Sometimes paraplegia also occurs as part of a vascular disease, namely when arteries are obstructed and the spinal cord is no longer supplied with sufficient blood to maintain its function.

Paraplegia after surgery on the cervical spine

Any operation can always lead to complications. Secondary bleeding and wound infections are the most common general surgical risks. It is important that patients respond early on postoperatively new complaints to draw attention. Should reappear after the operation Paralysis or Sensory disturbances it is important to act quickly. Cross-sectional imaging, i.e. a CT or MRT, should be performed to determine the cause of these neurological failures.
Sometimes it is Remnants of bone or disc tissuethat enter the spinal canal and then put pressure on the spinal cord. In this case must to be operated on again immediately to relieve the nerve fibers. Also through a Rebleeding the spinal cord can be compressed. If the spinal cord is under pressure, it should also be operated on again. With early surgical intervention you can permanent consequential damage can often be avoided.

Overall, the risk of permanent paraplegia after surgery on the cervical spine is considered very low to assess.

Symptoms of paraplegia

A number of symptoms can occur as part of paraplegia. The damage to the spinal cord results in a Interruption of the nerve tract. These lose their function. That's why next to one Sensory disturbance also the Musculature affected, paralysis occurs.
The extent of this paralysis can vary.

On the one hand it is crucial which one height spinal cord damage occurred. With a paraplegic syndrome in the area of Cervical spine It comes to Paralysis of the arms and legs. Also the Respiratory muscles can be affected.
If there is damage in the area of ​​the Thoracic spine or lumbar spine the arms can often be moved normally, but the parts of the body that are below the cross-section are paralyzed.
At the beginning of a paraplegic syndrome it is flaccid paralysis. The arms and legs hang limply from the body. Over time, however, the flaccid paralysis usually develops into one Spasticity. This is understood to mean an increase in tone, i.e. permanent tension, of the muscles.

The Emptying of the bladder and bowel is also controlled by the spinal cord. It is often disturbed by paraplegia. Injury to the spinal cord is not painful. But pain can be caused by one Vertebral fracture or the Injury to soft tissue structures occur.
Please also read our page Symptoms of a vertebral fracture.

Further information can be found on our website Symptoms of paraplegia.

Symptoms of the onset of paraplegia

The symptoms of the onset of paraplegia depend on the level at which the spinal cord is damaged. It comes to neurological failure symptoms. These can only start at the beginning at times occur and in their expression vary.
On the one hand, neurological failures are understood to mean Sensory disturbances how tingling pain or a Numbness. On the other hand, the patients complain about Musculoskeletal disorders such as a Muscle weakness. In the further course, the muscles even become paralyzed.

In addition to mobility problems, problems with the Bowel or bladder emptying occur. If such symptoms occur, it is important to consult a doctor immediately, because the onset of paraplegia can often be caused by a immediate surgical intervention be cured.

Please also read our page Cure for paraplegia.

Symptoms of incomplete paraplegia

A distinction is made between the symptoms complete and incomplete paraplegia. With a complete paraplegia there is a complete severing the nerve fibers in the spinal cord. As a result, the conductor paths are completely interrupted. The corresponding muscles can no longer be controlled by the nervous system and can therefore no longer be moved. A paralysis is the consequence.

If you have incomplete paraplegia not all nerve fibers a segment of the spinal cord has been severed. Some of the signals can still be passed on. Thus one remains Residual function the muscles are preserved, and sensitivity disorders are only less pronounced.

diagnosis

Suspicion of a Paraplegia the person concerned usually expresses himself. To confirm this, the doctor can use various tests and imaging methods, depending on the suspected cause.

If there is an accident, the doctor will either X-ray, one Computed Tomography (CT) or a Magnetic resonance imaging (MRI) with which one can recognize the fracture of a vertebral body and the crushing of the spinal cord on the resulting image. The images provided then provide information about the extent and localization of the damage, and they also help to decide whether an operation is necessary or not.

However, if the paraplegia has developed slowly, the doctor will do a thorough neurological exam. This includes several tests that check sensitivity and muscle strength. A blood test may be necessary to rule out or detect inflammation of the spinal cord.

Important differential diagnoses are paralysis caused by damage to the nerves in the brain or caused by a disease of the muscle itself. In these cases, however, the sensitivity is still intact.

Therapy of paraplegia

With complete paraplegia, they are operative therapy options often only slightly pronounced. One can for example broken vertebral bodies Surgical treatment so that further damage to the spinal cord is prevented. It can also be useful to remove part of the vertebral arch if there is a risk of swelling of the spinal cord.

Especially in the acute phase of paraplegia, which is also called spinal shock it is important that the Cardiovascular system is carefully checked and stabilized. This usually has to be done in an intensive care unit. It is also crucial that the lying patients are repositioned frequently, this is the only way to prevent pressure sores from developing on the skin as a result of lying for a long time.
Often it happens too Disorders of voluntary emptying of the bladder or bowel. Patients will often be with one Urinary catheter provided. Patients need medication that stimulates bowel movements.

During the inpatient stay, the Rehabilitation measures started to counteract stiffening of the joints. After the inpatient stay, a rehabilitation measure in a specialized center follows. For one, the patient gets physiotherapeutic and occupational therapy support. There are also those Coping with everyday life and the Maintaining independence in focus.

What does the cure for paraplegia look like?

A paraplegia that leads to a complete severing of the nerve fibers in the spinal cord is according to the current state of science not curable. However, there are promising approaches in the field of medical research regarding the regeneration of severed nerve fibers. These are usually still researched in animal experiments. Isolated clinical studies with small numbers of patients have already been carried out.
However, it must be seen to what extent these ideas also lead to a relevant functional improvement in the affected patient. Until these research results can then be routinely implemented on patients, there will be another one long time need. Whether a paraplegia will ever be curable cannot be foreseen even with promising research approaches based on the current state of science.

Please also read our page Cure for paraplegia.

forecast

Also the forecast of the Paraplegia depends on its cause. If the symptoms have gradually developed in the course of an illness, the muscle function can in some cases even be completely restored through early therapy, as parts of the nerves are still intact. However, if the spinal cord is completely severed, as is usually the case after an accident, then the damage is irreversible.

prophylaxis

Since the Paraplegia is most often the result of an accident, one should follow the rules and always behave carefully in traffic, and make sure to wear appropriate protective clothing both here (for example as a motorcyclist) and in extreme sports. To one disc prolapse one should always try to prevent the Spine not subject to excessive loads.

Summary

Paraplegia, or better: paraplegia syndrome, occurs most often as a result of an accident in which the spinal cord is injured.
The consequences are disorders of motor, sensory and vegetative functions, which, depending on the location of the damage, affect a part of the body of different sizes. Patients are usually dependent on a wheelchair and have to relearn many activities that were taken for granted in everyday life, as once the spinal cord has been severed, it cannot be reversed.