Why can spinal cord injuries lead to paralysis

Paraplegia

Causes & Symptoms

What is paraplegia?

Paraplegia is the result of damage to the spinal cord. The spinal cord is located in the spinal canal and is part of the central nervous system. It forwards information between the brain and the body. If damage occurs, the line is interrupted and usually cannot be restored.

A distinction is made between the extent of the injury

  • Paraplegia: This corresponds to damage in the thoracic vertebra area or below and means paralysis of both legs. One also speaks of a deep cross-section. The upper extremities remain functional, the respiratory muscles are in most cases not or only insignificantly impaired.
  • Tetraplegia: The legs as well as the arm and arm muscles are paralyzed, the damage is in the area of ​​the cervical spine. One also speaks of the high cross-section. Affected patients must also be artificially ventilated if the spinal cord is interrupted at the level of the fourth cervical vertebra or higher.

Causes: This is how paraplegia develops

As a rule, fractures of the spine, usually as a result of an accident, cause paraplegia. The vertebral bodies shift and the spinal cord is squeezed. Tissue swelling and bruising can also damage the spinal cord. In the course of the process, a scar is formed at this point, but the original connections remain broken and cannot be restored.

In addition to the effects of forces on the spine, diseases of the spinal cord or the surrounding structures can also indirectly lead to a disorder. These include tumor diseases, infections and diseases of the blood vessels, such as stroke or multiple sclerosis.

Paraplegia can also be congenital, as in spina bifida, which results from an incorrect development of the nervous system in the embryonic phase.

A herniated disc can also damage the spinal cord. Normally only individual muscles are paralyzed by the pressure of the intervertebral disc on the spinal cord. In the worst case, however, the spinal cord can be crushed.

Symptoms: signs of paraplegia

The failure of the muscles in the form of paralysis is the clearest symptom of paraplegia. The extent depends on how badly the spinal cord is damaged. Spinal cord damage as such does not hurt. Rather, the pain is caused by broken vertebrae or soft tissue injuries.

There are two types of paralysis:

  • Incomplete paralysis Not all nerve tracts are affected here. In spite of the paralysis of the muscles, the sensitivity, i.e. the emotional perception (pain, cold, warmth or touch), can be intact and vice versa.
  • Complete paralysis Patients do not feel the urge to stool or urinate. There is no sensitivity in the area of ​​the inner thighs and contraction of the anal muscle is also not possible.

In the first few weeks, those affected are in a state of so-called spinal shock. This leads to a complete flaccid paralysis and a loss of muscle stretching and external reflexes. The flaccid paralysis can last up to six weeks and resolve very slowly. Only then can the extent of the damage to the spinal cord be determined.

Other symptoms of paraplegia

Pressure sores as a result of excessive pressure on the skin are also typical. This becomes wedged between the base and the bones and is therefore insufficiently supplied with blood. Since pain is no longer perceived, no change in position is triggered. Mainly areas of the body where there is little soft tissue between skin and bones are affected, such as in the buttocks area.

Spasticity also occurs in many of those affected. Here the harmonious interplay of the flexor and extensor muscles is disturbed, and fine movements are difficult or impossible. After several weeks and months of damage to the spinal cord, the tension in the muscle increases.

Nerve pain occurs in up to half of all those affected. These can manifest themselves, for example, in a burning, tingling or electrifying feeling.

Due to the lack of movement and bone stress, 60 percent of all those affected develop osteoporosis. This leads to a continuous breakdown of the bone substance in the first two years after the trauma.

Diagnosis

This is how we diagnose paraplegia

First of all, our doctors determine the cause of the paraplegia. If the spinal cord damage was caused by an accident, the patients are first asked about the exact course of the accident as well as the beginning and duration of the symptoms. Here the doctor checks the motor skills and sensitivity of the body and limbs. He also checks the reflexes. In addition, he examines disorders of the bladder and rectum and clarifies any previous illnesses. Other possible neurological deficits are also examined.

Differential diagnosis in non-traumatic paraplegia

In the case of paraplegia that occurred without an accident, a so-called differential diagnosis is also required. The doctor checks whether and to what extent there are other diseases that lead to symptoms of paralysis and that are not caused by damage to the spinal cord. This means that in addition to changes in the structure of the spinal cord, diseases of the brain such as inflammation of the nervous system must also be taken into account.

X-rays decide whether to have an operation

Imaging procedures, such as x-rays of the spine and computer or magnetic resonance tomography of the spinal cord, provide information about bone injuries and damage to the spinal cord. Only after these examinations can a decision be made as to whether an operation makes sense.