Paraplegia

Overview

What is paraplegia?

Paraplegia is a specific pattern of paralysis (which is when you can’t deliberately control or move your muscles) that affects your legs. This happens because of a problem with your nervous system. Depending on how it happens, this paralysis may have different effects on some body systems or processes. Paraplegia is usually a symptom, but there are rare instances where it’s a specific condition on its own.

There are also two main ways that paraplegia can happen, complete and incomplete:

• Complete injury: This means a total loss of function, including the ability to feel sensation and move. Your body also can’t control automatic functions that rely on your spinal cord for relaying signals, such as controlling your bladder and bowels.
• Incomplete injury: This means a partial loss of function. You might still be able to feel or move body parts below the injury, but usually not as strongly as you could before the injury.

There are also two main ways that paralyzed muscles act in paraplegia:

• Flaccid paraplegia: This means that muscles don’t work at all and remain flaccid or limp.
• Spastic paraplegia: This is paraplegia that results in muscles that don’t work by themselves and contract uncontrollably.

How does the location of a problem affect paraplegia?

People with paraplegia have different symptoms depending on how high or low the injury is in their spine. Paraplegia generally affects your legs, but may also affect your abdominal muscles, making it difficult to cough. It can also affect your chest muscles, making it difficult to take deep breaths.

Your spine has multiple sections. Each section has several vertebrae (singular is vertebra). Your vertebrae are interlocking bone segments that make up your backbone and protect your spinal cord.

Paraplegia can happen with injuries in any of the following sections:

• Thoracic spine (T): This section (pronounced “tho-rass-ick”) is in your upper back. It has 12 vertebrae and 12 spinal nerves.
• Lumbar spine (L): This is in your lower back. It has five vertebrae and five spinal nerves. Your spinal cord ends at the first lumbar vertebrae, but several spinal nerves continue downward and exit between the vertebrae below.
• Sacral spine (S): These vertebrae are where your spine and pelvis (hip bones) join together. There are five sacral vertebrae and nerves.

Healthcare providers use a letter-number combination to talk about sections of the spine and related spinal nerves. For example, T1 is the spinal nerve that runs between the first and second thoracic vertebra.

The effects of paraplegia generally are as follows:

• Injury between spinal nerves T1 and T6: This causes complete paraplegia. Hips and legs are paralyzed and have no feeling at all, as are the abdominal muscles. This also causes loss of bladder and bowel control. Injury at this level can cause problems with coughing and deep breathing.
• T7-T12: Complete paraplegia like above, but chest muscles aren’t affected.
• L1 to L2: Complete paraplegia like above, but chest and abdominal muscles aren’t affected. You still need a wheelchair for mobility, and you may not have bowel and bladder control.
• L3 to S5: Incomplete paraplegia becomes more common the farther down the spine an injury occurs. At this level, you can usually walk with or without braces or a walker. However, bowel movements and bladder function may be affected.

Peripheral nerve problems

Paraplegia can happen with problems of your peripheral nerves, which are the nerves that extend outward from your spinal cord. These usually happen because of diseases and conditions that affect multiple nerves at the same time (polyneuropathies), like Guillain-Barré syndrome or diabetes-related nerve damage (neuropathy).