What is Paraplegia?

Paraplegia is a condition in which a person has paralysis (lost muscle function and possibly sensation) in the legs and lower torso.

Paraplegia often involves loss of sensation (of pain, temperature, vibration, and position) as well as loss of motion. It may also include paralysis of the bladder and bowel. Paraplegia may be caused by injury to or disease of the lower spinal cord or peripheral nerves or by such brain disorders as cerebral palsy. Some paraplegics are able to walk with the aid of braces and crutches. Quadriplegia involves paralysis of both arms and both legs.

It is most commonly caused by injury to the spinal column below the first thoracic vertebrae, T1. The thoracic, lumbar or sacral area of the spine are the vertebrae below the cervical section of the spine.

Injuries above the first thoracic vertebrae generally result in quadriplegia.

Hereditary Spastic Paraplegia (HSP)

Hereditary spastic paraplegia is a rare type of paraplegia that is hereditary in nature and that can progress from a stiffness felt in the legs to full spastic paralysis. Spastic paralysis is a type of paralysis where the muscles are stiff, lack coordination, and subject to uncontrollable spasms that result in jerky movements.

This is a progressive condition that normally appears in early- through middle-aged adulthood but can begin at any age.

Causes of Paraplegia:

Injury: Paraplegia is caused primarily by injury to the thoracic area of the spinal cord. This damage can be caused by accidental events such as falling, vehicle accident, sports injury, etc.

Disease: Paraplegia can also be caused by a variety of diseases and conditions such as spina bifida , cerebral palsy, tumours etc.

Symptoms of Paraplegia

The severity and extent of the paralysis will depend on what level of the spine has been damaged. Damage to the top section, the thoracic area of the spine, will produce a more severe disability than an injury in the lower section, the sacral area of the spine.

In the list below T1 through 12 refer to the thoracic area of the spine, L1 through L5 will refer to the lumbar area of the spine and S1 through S5 will refer to the sacral area of the spine.

T1 Damage:  Individuals can experience limitations to fingers and small hand muscles.

T1 to T12 Damage:  Individuals can have some dysfunction of the chest wall and abdominal muscles.

T10 to L2 Damage:  Male individuals can have some difficulty with thought controlled erections.

L2 Damage: Individuals ability to bend at the hip can be impaired.

L1 to L4 Damage:  Individuals can have difficulty with thigh flexion.

L2 to L4 Damage:  Individuals can have difficulty extending the knee and with adduction (pull the thighs together) of the thighs.

L4 to S1 Damage:  Individuals can have difficulty with abduction (spread the thighs apart) of the thighs, dorsiflexion of the foot (flexing the foot up) and extension of the toes.

L4 to S2 Damage:  Individuals can have difficulty flexing the knee (hamstrings).

L5 to S2 Damage:  Individuals can have trouble extending the leg from the hip, flexing of the toes, plantar flexion of the foot (bending the foot down).

S2 to S4 Damage:  Male individuals may have trouble attaining a reflex erection and achieving ejaculation.

S3 to S5 Damage:  Can affect the bladder, bowel and sex organs and the anal and other pelvic muscles.
The severity and number of symptoms of paraplegia will escalate as the height of the spine where the damage occurs escalates. For instance, L2 damage can affect the ability to bend at the hip but the ability to bend at hip can be impaired by damage at any point above L2 as well.

People suffering from paraplegia can be especially prone to developing pressure sores if they have a loss of sensation in the buttock area. They cannot feel discomfort and aren’t triggered to shift their weight as unaffected people would be. Pressure sores can develop in relatively short periods of time, are the result of a combination of heat, moisture and pressure, take months to heal and can easily reoccur once healed.

What are the first signs of paraplegia?

Most people find they can no longer feel their legs immediately after the accident. The first signs of paraplegia are numbness and immobility in the legs, accompanied by extreme back pain. Once the accident victim has been rescued (which should only be done by qualified experts), they are operated on to fix the break in the dorsal vertebra. Depending on their injury, patients will have to spend several weeks in a special clinic or hospital, until the break in their back is mended. After this, patients have to be remobilized. In a rehabilitation program that usually lasts several months, patients with paraplegia gradually learn how to cope with the consequences of their disability. After rehabilitation, persons with paraplegia have a good chance of resuming their normal lives without outside help.

What parts of the body are affected be paraplegia?

Depending on where the back was injured, the paralysis can affect different parts of the body. Paraplegia is the result of an injury to the spine at the level of the thoracic or lumbar vertebra. For most people with paraplegia, the legs and usually parts of the torso are paralyzed. Paralysis means that the muscles in the legs, stomach, back, and possibly also the chest, no longer function. The person affected can no longer walk or stand. The paralysis in the legs is often spastic, which means that the muscles sometimes cramp together. Many people with paraplegia have difficulty sitting up straight.

Does paraplegia also cause loss of feeling?

The musculature is not the only thing that’s lost at the point of the paralysis – the sensation of feeling goes too. People with paraplegia have no feeling of touch or position in the paralyzed parts of their body. They feel neither pain nor temperature in the affected areas. Because the skin can no longer perceive injury, those affected are at risk of burns or injuries from pressure sores (decubitus ulcer).

Are the excretory organs also affected by paraplegia?

One of the hardest things for people with paraplegia to bear are disorders of the excretory organs. Both the bladder and bowels no longer functions correctly. Fifty years ago, these disorders of the excretory organs used to cost most patients their lives after only a few years. Thanks to medical advances (such as self-catheterization), these problems are no longer life-threatening. However, most patients do find them socially limiting.

How does paraplegia affect sexuality?

Men with paraplegia have problems in achieving a full erection. Both men and women can find their capacity for orgasm is impaired. Despite this, many people describe their sex life as satisfying. Men with paraplegia can father children. Women may become pregnant spontaneously. In most cases, both pregnancy and birth proceed normally.