paraplegia

 

(pâr'əplē'jēə) , paralysis of the lower part of the body, commonly affecting both legs and often internal organs below the waist. When both legs and arms are affected, the condition is called quadriplegia. Paraplegia and quadriplegia are caused by an injury or disease that damages the spinal cord, and consequently always affects both sides of the body. The extent of the paralysis depends on the level of the spinal cord at which the damage occurs. For example, damage to the lowest area of the cord may result only in paralysis of the legs, whereas damage farther up on the cord causes possible loss of control over the muscles of the bladder and rectum as well or, if occurring even higher, may result in paralysis of all four limbs and loss of control over the muscles involved in breathing.

Most frequently the cause is an injury that either completely severs the spinal cord or damages some of the nervous tissue in the cord. Such damage could result from broken vertebrae that press against the cord. Diseases that cause paraplegia or quadriplegia include spinal tuberculosis, syphilis, spinal tumors, multiple sclerosis, and poliomyelitis. Sometimes when the disease is treated and cured, the paralysis disappears, but usually the nerve damage is irreparable and paralysis is permanent. Treatment of paraplegia and quadriplegia is aimed at helping to compensate for the paralysis by means of mechanical devices and through psychological and physical therapy.

Paraplegia
Classification & external resources

MeSH	D010264

Paraplegia is an impairment in motor and/or sensory function of the lower extremities. It is usually the result of spinal cord injury or a congenital condition such as spina bifida which affects the neural elements of the spinal canal. The area of the spinal canal which is affected in paraplegia is either the thoracic, lumbar, or sacral regions. If the arms are also affected by paralysis, quadriplegia is the proper terminology.

Causes

The causes range from trauma (acute spinal cord injury: transsection or compression of the cord, usually by bone fragments from vertebral fractures) to tumors (chronic compression of the cord), myelitis transversa and multiple sclerosis.

Central Nervous System (CNS)

Any disease process affecting the corticospinal or pyrimidal tracts of the spinal cord from the thoracic spine downward may lead to paraplegia. These tracts are responsible for movement or the "instructions" for movement from the brain to the anterior horncells respectively. The most common cause of paraplegis (and all spinal cord injuries) is motor vehicle accidents. Other causes include violence, sports, cancer (tumors) involving the epidural or dural space, vertebral fractures) and myelitis transversa. Gunshot wounds to the spine, although decreasing, are one of the major causes of paraplegic spinal cord injuries (for instance, Ron Kovic, author of Born on the Fourth of July, is a paraplegic as a result of a gunshot wound suffered in the Vietnam War). Sometimes, paralysis of both legs can result from injury to the brain (bilateral injury of the motor cortex controlling the legs, e.g. due to a stroke or a brain tumor).

Peripheral nervous system

Rarer is the type which is caused by damage to the nerves supplying the legs. This form of damage is not usually symmetrical and would not cause paraplegia, but polyneuropathy may cause paraplegia if motor fibres are affected. While in theory the arms should also be affected, the fibres that supply the legs are longer and hence more vulnerable to damage. Larry Flynt, noted pornography magnate, sustained this form of nerve damage when he was shot in a murder attempt in 1978, rendering him paraplegic.

Disability

While some people with paraplegia can walk to a degree, many are dependent on wheelchairs or other supportive measures. Impotence and various degrees of urinary and fecal incontinence are very common in those affected. Many use catheters and/or a bowel management program (often involving suppositories, enemas, or digital stimulation of the bowels) to address these problems. With successful bladder and bowel management, paraplegics can virtually prevent all accidental urinary or bowel discharges; it is however another option for the patient to wear undergarments such as diapers to further protect from bladder or fecal incontinence. Some prefer diapers for the comfort level they provide.

Complications

Due to decreased movement and loss of the ability to run, paraplegia may cause numerous medical complications, many of which can be prevented with vigilant self care. These include pressure sores (decubitus), thrombosis and pneumonia. Physiotherapy and various assistive technology, such as a standing frame, may aid in preventing these complications.

Support organizations

• Back-Up Trust
• Spinal Cord Injury Peer Support
• Spinal Cord Injury Support
• Canadian Paraplegic Association

See also

• Quadriplegia
• Cauda equina syndrome

Cerebral palsy and other paralytic syndromes (G80-G83, 342-344)
Paresis and plegia NOS	Paralysis - Quadriplegia - Triplegia - Hemiplegia/Hemiparesis - Paraplegia/Diplegia - Monoplegia
Flaccid vs. spastic	Flaccid paralysis - Spastic diplegia - Spastic paraplegia
Specific types	Cerebral palsy - Cauda equina syndrome - Locked-In syndrome

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