Introduction

Paralysis is a condition where nerve signals are disrupted on the pathway to muscles, causing voluntary muscle movement. Any problem affecting the nervous system can lead to paralysis. Paralysis can be temporary or permanent, based on the condition affecting the nervous system.^1,2

The nervous system is responsible for sending motor signals from the brain to the body and bringing back sensory signals from our skin to the brain. It’s in a constant feedback loop. Any damage to the nervous system delivering messages from the brain to the muscles can cause paralysis. 

Paraplegia is a condition where there is a loss of motor, sensory and limb function in the lower part of the body. It can occur after trauma, accidents or disease that impacts the spinal cord. Paraplegia affects the mobility and normal function of the area below the injury in the spinal cord.^1,2

Paraplegia has its own issues depending on how and where the injury occurs on the spinal cord. The ability of movement, sensation and control of the arms and legs is also dependent on where the injury occurs. 

Paraplegia can be a pretty complex condition. In this article, we aim to clear up your questions on the causes and symptoms of paraplegia.  

Paraplegia

Paraplegia is a symptom of paralysis, affecting the lower body, with loss of one’s ability to move their legs and control their muscles. There are two types of paraplegia:²

• Complete injury
  • Total loss of sensation and movement below the area of the spinal cord injury 
  • The spinal cord cannot relay any signals regarding bowel and bladder control function

• Incomplete injury
  • Partial loss of function, where some movement remains below the affected area

Paralysis classified includes:^3,4

• Flaccid paraplegia
  • The muscles do not work, they become floppy or shrink

• Spastic paraplegia 
  • The muscles tighten causing them to contract uncontrollably and resist being stretched

Spine and paraplegia

The spine is an important structure that supports the body and supports movement. It is made up of the spinal cord (bundles of tissue, nerves and cells) and the vertebral column (a structure of connected bones that surrounds and protects the spinal cord). Paraplegia generally affects the limbs but it can also affect the abdominal muscles. The spine is classified into segments according to their position:^1,2 

• Cervical spine (neck)
  • Consists of seven vertebrae (C1 to C7). 
  • Provides support to the head and enables it to move^5,6

• Thoracic spine (chest)  
  • Thoracic spine (T) makes up the middle section of the spine, starting from the base of the neck and end at the bottom of the where the ribs 
  • Consists of 12 vertebrae (T1 to T12) and 12 spinal nerves. 
  • The thoracic spine is rigid and stable, so it is the least common area of injury⁷

• Lumbar spine (lower back)  
  • The lumbar spine (L) has 5 vertebrae (L1 to L5) and 5 spinal nerves. 
  • The Lumbar spine provides support to the weight of the body⁸

• Sacrum
  • The sacral spine (S) is the triangle-shaped bone that connects the hips. 
  • There are 5 sacral vertebrae (S1 to S5) that fuse during foetal development⁹

• Coccyx (tailbone)
  • This is the last bone at the base of the spine, where 3 to 5 vertebrae have fused together to make the small coccyx bone. 

Effect of paraplegia

• Spinal nerve T1 - T6
  • Injury between these thoracic spinal nerves causes complete paraplegia. 
  • Causes complete paralysis of the legs and abdominal muscles, causing loss of bladder control and can also affect the chest muscles. 

• Spinal nerve T7 - T12
  • Injury between these thoracic spinal nerves causes complete paraplegia. 
  • The chest muscles are not affected.

• Spinal nerve L1 - L2
  • Injury in the lumbar area causes complete paraplegia and the loss of bladder and bowel control.

• Spinal nerve L3 - S5
  • Injury in this lumbar and sacral spine area causes incomplete paraplegia. 
  • Patients may need to walk with the help of a frame, walker or braces. 
  • Bladder function and bowel movements are also affected.

Symptoms

• Loss of movement
• Loss of bladder control and bowel movements
• Trouble breathing and coughing
• Loss of sensation causes difficulty in feeling heat, cold and touch
• Changes in sexual function and fertility
• Intense pain or stinging sensation in the spinal cord caused by damage to the nerve
• Difficulty in walking or standing
• Loss of balance
• Loss of control of the body
• Extreme pain or pressure
• Numbness or tingling sensation in the hands, fingers, toes or feet
• Difficulty in breathing after an injury

Causes

Paraplegia is commonly caused by injury to the spinal cord. Injuries can happen in many different ways and it can affect different areas of the spinal cord. Some of the causes are: 

• Injury from a fall
  • Elderly people are more vulnerable due to conditions like osteoporosis, a condition that weakens bone density and increases the risk of fractures. 
• Car Accident
• Penetrating injuries from stab wounds or gunshot wounds
• Injuries during sports activities
• Cancer or tumour that develops around the spinal cord
• Infections that compress the spinal cord
• Decreased blood flow
• Diabetes causing nerve damage
• Congenital conditions such as myelomeningocele (a type of spina bifida where the spine and spinal cord don’t close before birth) or spina bifida (a neural tube defect where a baby’s spine and spinal cord don’t develop properly)¹⁰
• Cerebral palsy, a neurological condition occurs when there is brain damage during foetal development, affecting the control of muscle movement¹¹
• Autoimmune conditions like Guillain-Barre syndrome or multiple sclerosis 

Diagnosis

The healthcare provider or neurologist (specialising in conditions related to the brain and nervous system) will consider any history you may have, including accidents or diseases and will conduct physical examinations. They may also take investigation scans including:

• X-rays
  • An imaging test that uses a safe amount of radiation to create images of bone and soft tissues
  • Identify the damage to the bone (vertebrae) surrounding the spinal cord and can locate any tumours or changes in the spine

• CT scan
  • Computed tomography is an imaging test similar to an X-ray but the images are far more detailed
  • The scan gives cross-sectional images of the bones, muscles, organs and even blood vessels

• MRI scan
  • Magnetic resonance imaging technique is a non-invasive imaging test that gives even more detailed images of the internal structure like organs, bones, blood vessels and muscles

Management and treatment

Treatment for paraplegia depends on causative factors and where it has affected the spinal cord. To fully recover from paraplegia is difficult and the damage it causes to the spinal cord varies in different situations. Spinal cord treatment mainly focuses on preventing further damage and assisting the patient to return to an active, normal lifestyle. The early stage of treatment includes: 

• Prevention of further spinal cord damage if there is a neck injury
• Maintenance of normal breathing.
• Avoidance of possible complications like respiratory or cardiovascular conditions as well as urine or stool retention

• Immobilisation
  • Healthcare providers use traction to stabilise the spine and pull the head gently for proper alignment

• Surgery
  • Often surgery is required to remove foreign bodies like cancer tumours or any objects that compress the spine
  • This helps in reducing the pain and further complications

• Rehabilitation
  • A team of doctors and therapists  work alongside a patient to maintain and strengthen muscle function and redevelop fine motor skills
  • They will help with using a wheelchair, to support the patient in enjoying their hobbies
  • They will also encourage patients in social participation and fitness activities

Complications

Doctors and therapists mainly work to reduce the complications of spinal injury. Complications differ according to the causative factor and area affected. Spinal cord injury can lead to some complications that include: 

• Loss of sensation
• Decreased blood flow
• Decreased control of bowel movements, patients are encouraged to have a high-fibre diet
• A decrease in bladder control can cause urinary tract infection, and kidney stones and affect controlling or emptying the bladder
• Muscle tone
  • People with spinal cord injury experience tightening or softening of muscles, which can lead to a lack of muscle tone
• Difficulty in breathing and coughing
• Depression
  • Pain, restricted mobility and changes in lifestyle often cause depression in some people
• Fitness
  • Spinal cord injury often leads to weight loss and muscle thinning 
  • Also, due to sedentary lifestyle and decreased mobility, it can lead to weight gain, diabetes and cardiovascular diseases

FAQs

Can people with paraplegia walk?

People whose spinal cord injury is incomplete, can participate in rehabilitation programs and gain the ability to walk with the help of a walking device. However, for those with complete spinal cord injury, they will lose their ability to walk. 

What level of injury is paraplegia?

Spinal cord injury affecting the thoracic vertebrae (T2 - T12) can lead to paraplegia. This affects the legs leading to loss of sensation and movement in the lower part of the body.

Is paraplegia a disability?

Paraplegia is a symptom of paralysis affecting the lower body, causing difficulty in walking or standing. Paraplegia is a disability.

Summary

Paraplegia is a condition where there is a loss of motor, sensory and limb function in the lower part of the body. It occurs as a result of trauma, accidents or disease that affects the spinal cord. 

Paraplegia affects the area below the injury, impairing movement and its normal functions. 

Paraplegia is classified into two types, complete and incomplete. It is an injury where there is a total loss of sensation and movement below the spinal cord injury as well as loss of bladder and bowel control. In incomplete injury, there is only a partial loss of function, where some movement remains below the affected area. 

To fully recover from paraplegia is difficult and the damage it causes to the spinal cord varies in different situations. Spinal cord treatment mainly focuses on preventing further damage and helping the patient return to an active normal lifestyle with the help of rehabilitation.