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).

Possible Causes

What are the most common causes of paraplegia?

The most common cause of paraplegia is injury to your spinal cord. Those injuries can happen in many different ways. The most common reasons are:

  • Motor vehicle crashes.
  • Penetrating injuries (especially from gunshot or stab wounds).
  • Falls (especially in older adults with bone density-related conditions like osteoporosis or osteopenia).

Other common causes of paraplegia include:

  • Spine tumors, including cancers. This can involve cancer that develops on or around your spinal cord, or that starts elsewhere in your body and spreads to your spine.
  • Cysts or fluid-filled cavities within your spinal cord (syringomyelia).
  • Infections that attack or compress your spinal cord.
  • Lack of blood flow (ischemia) due to a blocked blood vessel or blood vessel rupture.
  • Diabetes-related nerve damage.
  • Congenital conditions (that you have when you’re born) where you have a problem with your spine or spinal cord structure, such as myelomeningocele or spina bifida.
  • Injuries that happen during birth or very early childhood, causing conditions like cerebral palsy.
  • Autoimmune or inflammatory conditions like Guillain-Barré syndrome, multiple sclerosis or transverse myelitis.
  • Genetic conditions like hereditary spastic paraplegia.

Care and Treatment

How is paraplegia treated?

The treatments for paraplegia depend on what caused the issue and where it is in your spinal cord. The injuries and conditions that can cause paraplegia can vary widely, and the potential to recover from them can also vary. Because of that, a healthcare provider is the best person to explain the situation. They’ll offer you guidance for your specific situation, including the possible treatments and the side effects or complications that can happen with those treatments.

What can I do at home to treat paraplegia?

Paraplegia is a key symptom of a spinal cord injury or a condition that affects your nervous system. These injuries and conditions are almost always medical emergencies. The only exceptions to this are when a healthcare provider diagnoses you with a medical condition that can lead to paraplegia. In those cases, a healthcare provider will provide guidance on what to do if and when paraplegia develops.

IMPORTANT: If you’re with someone who has an injury that could affect their spine, it’s very important that you call 911 (or your local emergency services number immediately) and avoid doing anything that could make the injury worse.

Moving someone with a possible spinal cord injury in the wrong way can cause permanent damage. Because of this, only trained professionals should move someone with a suspected spinal cord injury. The ONLY exception to this is if the person is in immediate danger if you don’t move them (such as from a motor vehicle crash where the vehicle the person is in may catch fire).

How can paraplegia be prevented?

Paraplegia is sometimes preventable, but it also happens unpredictably, and in ways you can’t prevent. The best things you can do to prevent paraplegia or reduce your risk of developing it are:

  • Wear safety equipment, including safety restraints (like seat belts) as recommended. Seat belts and other restraints can help avoid injuries that could lead to paraplegia.
  • Be careful when using firearms. Gunshot wounds are one of the most common causes of spinal cord injuries that lead to paraplegia. You should ALWAYS treat firearms with extreme caution, no matter the circumstance. Act as if they’re loaded even if you’re absolutely certain they aren’t. You should also store firearms unloaded, secured with a trigger lock and out of reach of children. It’s also wise to store ammunition separately under lock and key.
  • Take precautions to avoid falls. Use safety equipment, especially safety harnesses, when working on a roof or another elevated environment. You should also take steps to avoid falls in the home, especially with stairs or in bathrooms. This can include installing handrails, using non-slip footwear and floor surfaces, keeping stairs clear of tripping hazards.
  • Avoid misusing prescription medications, recreational drugs and alcohol. These can affect your immune system’s ability to fight infection. They can also increase your risk of injury from falls, car crashes, etc.

When to Call the Doctor

When should paraplegia be treated by a doctor or healthcare provider?

A healthcare provider should ALWAYS examine and treat paraplegia.

Frequently Asked Questions

What’s the difference between paraplegia and tetraplegia?

Paraplegia is paralysis that affects your legs. Tetraplegia — also known as quadriplegia — is paralysis that affects your arms and legs.

What’s the difference between paraplegia and hemiplegia?

Paraplegia and hemiplegia have a few similarities, but they usually happen in very different ways and for different reasons.

  • Paraplegia: This is paralysis that affects your legs and sometimes the lower half of your body.
  • Hemiplegia: This is paralysis that affects one side of your body, either left or right. It can involve your arm, leg or one side of your face, or a combination of these three.

What is hereditary spastic paraplegia?

This condition refers to a group of disorders inherited from one or both parents. These disorders disrupt your nervous system, causing paralysis in your legs. The paralysis involves constant muscle movements that a person can’t control (which is why the word “spastic” is part of the name). This condition can happen on its own, or it can happen along with other medical conditions. It’s also progressive, meaning it gets worse over time.

A note from Cleveland Clinic

Paraplegia is paralysis that affects your legs, but not your arms. This symptom is most likely to happen with injuries, but can also happen because of diseases or medical conditions. Paraplegia that happens with injuries is a medical emergency and needs immediate medical care. Preventing further injury is critical to reducing the risk of permanent paralysis. While paraplegia can be frightening, there are also many options to help people recover from or adapt to it. Even when paraplegia happens because of permanent damage, it’s possible to adapt and find ways to live independently and have a fulfilling and enjoyable life.

Last reviewed by a Cleveland Clinic medical professional on 08/10/2022.

References

  • Adigun OO, Reddy V, Varacallo M. Anatomy, Back, Spinal Cord. (https://www.ncbi.nlm.nih.gov/books/NBK537004/) [Updated 2021 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 8/10/2022.
  • Bennett J, M Das J, Emmady PD. Spinal Cord Injuries. (https://www.ncbi.nlm.nih.gov/books/NBK560721/) [Updated 2022 May 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 8/10/2022.
  • Diseases of the Peripheral Nerves. In: Ropper AH, Samuels MA, Klein JP, Prasad S, eds. Adams and Victor's Principles of Neurology, 11e. McGraw Hill; 2019.
  • DiTommaso C, Kopp F, Linville CR. General Topics in Inpatient Rehabilitation. In: Mitra R, eds. Principles of Rehabilitation Medicine. McGraw Hill; 2019.
  • Genetic and Rare Diseases Information Center (GARD) | rarediseases.info.nih.gov. Hereditary spastic paraplegia. (https://rarediseases.info.nih.gov/diseases/6637/hereditary-spastic-paraplegia) Accessed 8/10/2022.
  • Kaiser JT, Lugo-Pico JG. Neuroanatomy, Spinal Nerves. (https://www.ncbi.nlm.nih.gov/books/NBK542218/) [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 8/10/2022.
  • Keenan ME, McMahon PJ. Rehabilitation. In: McMahon PJ, Skinner HB, eds. Current Diagnosis & Treatment in Orthopedics, Sixth Edition. McGraw Hill; 2021.
  • National Spinal Cord Injury Statistical Center, Facts and Figures at a Glance. Birmingham, AL: University of Alabama at Birmingham, 2021.
  • Oropello JM, Mistry N, Ullman JS. Spinal Injuries. In: Hall JB, Schmidt GA, Kress JP, eds. Principles of Critical Care, 4e. McGraw Hill; 2014.
  • Paralysis and Weakness. In: Ropper AH, Samuels MA, Klein JP, Prasad S, eds. Adams and Victor's Principles of Neurology, 11e. McGraw Hill; 2019.
  • St John Ambulance | sja.org.uk. Spinal injury. (https://www.sja.org.uk/get-advice/first-aid-advice/bones-and-muscle-injuries/spinal-injury/) Accessed 8/10/2022.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy