People who develop paralysis due to spinal cord injury have to learn many medical terms they may not have heard before, as well as struggling with many health problems. Understanding the medical terminology associated with the disease can help you discuss your problems more with your doctor. Patients hospitalized in physical therapy and rehabilitation clinics due to spinal cord paralysis are generally treated with the diagnosis of paraplegia or tetraplegia. So what do paraplegia and tetraplegia mean?
Tetraplegia is a clinical picture that develops in injuries on the first dorsal spine (thoracic vertebra) in the spinal cord. In other words, injuries from neck levels C1 to C8 can result in tetraplegia. Weakness and loss of sensation occur in both arms and legs. The severity of the stroke varies with the level and severity of the injury. A partial or complete spinal cord injury may occur. The higher the level of injury, the more severe the consequences. For example, in injuries at C3, C4, C5 levels, even the diaphragm, which is the respiratory muscle, may be affected, and the person may need respiratory support. If the injury is at a lower level, the functions governed by the higher levels are preserved. For example, in C8 level injury, while elbow and wrist movements are preserved, finger movements are weak.
Nerve injuries occurring outside the spinal canal at the brachial plexus or peripheral nerve level are not classified as tetraplegia. Although arm paralysis is seen in such injuries, the trunk and legs are not affected.
Spinal cord injuries lower than the first dorsal spine, that is, injuries from T1 to the sacral level, result in paraplegia. In other words, the level of paraplegia can be from T1 to T12, from L1 to L5 or at S1-2 level. Paraplegia is a milder condition than tetraplegia. They can use their arms and hands normally. However, depending on the level of injury, there is weakness in the trunk and leg muscles in varying degrees. Some patients have no strength in their legs. Others have some voluntary control. Depending on the strength in their legs, paraplegics can walk with assistive devices such as long walking device and crutches.
Cauda Equina Syndrome
Not every spinal injury results in a spinal cord injury. Injuries at the lowest levels may damage not the spinal cord itself, but the bundle of nerves emerging from it. In this case, a condition called cauda equina syndrome may occur. Cauda equina syndrome and a similar picture, the conus medullaris syndrome in which the lowest end of the spinal cord is damaged, are also classified as paraplegia. In both, problems such as impaired bladder control (incontinence, inability to urinate), sexual dysfunction, and weakness in leg control can be seen. Impairment of bladder and bowel control, sexual dysfunctions are also seen in paraplegia and tetraplegia.
Nerve injuries occurring outside the spinal canal, such as the lumbosacral plexus or peripheral nerve injuries, are not classified as paraplegia.
Tetraparesis and Paraparesis
The suffix -paresis can be used to describe partial paralysis. -plegia is used to express complete paralysis. Actually, tetraparesis and paraparesis are not officially accepted nomenclature. The distinction between complete and partial paralysis is determined according to the standard examination method called AIS (ASIA Disorder Scale), and staging is made as A, B, C, D, E. Stage A refers to complete paralysis, while others refer to partial paralysis.
How Is Injury Level Determined?
The level of spinal cord injury is determined by clinical examination . Imaging methods such as X-ray and MRI can indicate the level of damage anatomically, but this is not always the same as the level determined by clinical examination. For example, a person with an injury at the L1 vertebra (spinal bone) level in MRI and CT scans may have an L4 level determined by examination. Because the bone level and the spinal cord segment level are not exactly the same. In addition, the level may change over time and with physical therapy. For example, someone with an injury level of C8 at the first examination may be T1 at subsequent examinations, that is, they may show improvement. However, the bone level detected in imaging always remains the same.