The Tetraplegia , Also known as quadriplegia, is a sign characterized by total or partial paralysis of the upper and lower extremities.
This alteration occurs due to an injury in the spinal cord . Specifically, damage to some of the first thoracic vertebrae can lead to tetraplegia.
Quadriplegia usually affects cervical spinal nerves and, in addition to causing paralysis in all four limbs of the body, can also affect other regions such as the abdomen or chest, causing respiratory difficulties.
The main causes that can give rise to these signs are the injuries suffered in serious accidents and certain pathologies such as transverse myelitis, poliomyelitis or Spina bifida .
Likewise, tetraplegia is usually associated with several complications secondary to the paralysis it causes, such as the risk of infection, reduced mobility, pressure ulcers or involuntary control of the bladder and bowel.
In this article, the main characteristics of this condition are postulated. The signs, symptoms and causes of tetraplegia are reviewed and the interventions to be performed in individuals suffering from this type of injury are discussed.
Characteristics of tetraplegia
Tetraplegia is a condition that occurs when the person suffers a spinal cord Above the first thoracic vertebra.
This injury is characterized by affecting the cervical spinal nerves and generates a total or partial paralysis of the arms and legs.
In this sense, it is determined that a person suffers tetraplegia when unable to move their lower and upper extremities due to damage to the cervical vertebrae of the spinal cord.
In general, individuals with tetraplegia are not able to regain their ability to move, so it is considered a condition that is usually chronic.
However, in some rare cases, the person may recover some movement if he or she performs an intensive rehabilitation.
Although paralysis of the arms and legs is the pathognomonic attribute of this spinal sign, tetraplegia can cause other symptoms such as weakening of the muscles of the abdomen and chest.
This factor, in conjunction with movement paralysis, is often related to several of the complications that may result from quadriplegia.
People with this condition often have a high risk of developing an infection, frequent and long hospitalizations, sensitivity alterations and deterioration of their respiratory function.
Tetraplegia and spinal cord injury
Damage to the spinal cord usually results in highly complex conditions. Each lesion is different because it can damage different regions of the spinal cord, so they often cause different signs and symptoms.
Of all spinal cord injuries, tetraplegia is probably the most serious type of cervical injury and difficult to rehabilitate.
The spinal cord forms a channel that runs through the spine from the brain areas to the lumbar regions. The main purpose of this structure is to transmit the nerve impulses of the brain to the extremities of the organism.
In this sense, the more intense the injury, ie, more damage occurs in the spinal cord, the more complicated the treatment of tetraplegia.
At present, there is a high consensus that cervical trauma is a chronic condition, so quadriplegia is an irreversible condition.
However, research is advancing in search of solutions to regenerate spinal cord injuries, mainly through the application of mother cells . This line of study posits the possibility of, in the future, to find therapeutic tools to intervene in pathological conditions such as tetraplegia.
Injury that causes tetraplegia
Lesions that cause tetraplegia are characterized by affecting a particular area of the spinal cord. Specifically, this sign arises when one of the first seven vertebrae of the marrow are damaged, which are known as cervical vertebrae.
In this sense, tetraplegia develops due to a lesion in the upper region of the spinal cord, that is, in some of the vertebrae that are located in the neck area.
The seven cervical vertebrae of the spinal cord are called by the letter C and the corresponding number. The vertebra closest to the brain is called C1, the next C2, the third C3, the fourth C4, the fifth C5, the sixth C6 and the seventh C7.
The specific study of each of the cervical vertebrae of the spinal cord has allowed to determine what type of signs can be suffered when injuries occur in each one of them. The main ones are:
- Injuries to the vertebrae above C4 can cause total or partial dysfunction of the person's respiratory capacity.
- Injuries to the C5 vertebra often cause paralysis of the hands and fists, but they do not usually affect the shoulders and upper limbs of the biceps.
- Injuries to the C6 vertebra cause a total loss of hand functionality, but allow control over the fist.
- Injuries to the C7 vertebra cause skill problems and cause paralysis in the hand and fingers, but does not affect the ability to stretch the arm.
As can be seen, any injury to the cervical vertebrae of the spinal cord can cause tetraplegia, but each one will generate a different clinical picture.
In addition, it is necessary to take into account that the injuries in the spinal cord do not usually damage a single vertebra, but it is usually habitual that it affects more than one.
Thus, tetraplegia is defined as an alteration characterized by affecting the cervical vertebrae of the spinal cord and causing total or partial paralysis of the person's ability to move the extremities.
Signs and symptoms
In general, lesions affecting the upper cervical vertebrae of the spinal cord generate paralysis typical of tetraplegia. In contrast, injury to the lower vertebrae may lead to minor alterations.
In this sense, the symptomatology of quadriplegia may vary slightly in each case. For example, a person with this condition may have paralysis in the arms and legs, as well as elevated breathing difficulties. On the other hand, another individual with tetraplegia may have only paralysis in the legs.
As has been commented, the symptoms of this alteration depend mainly on the injured cervical vertebrae. Any of the following signs may be associated with tetraplegia:
- Total or partial paralysis in the arms.
- Total or partial paralysis of the legs.
- Total or partial paralysis in the hands.
- Depression or breathing difficulties.
- Loss of dexterity or motor difficulties.
- Inability to maintain balance or walk.
- Experimentation of involuntary and uncontrollable movements.
Types
Although each case of tetraplegia may have different forms, two main types have now been classified: total tetraplegia and partial tetraplegia.
Total tetraplegia is characterized by causing total paralysis in the four limbs of the organism, so that the person loses all movement capacity.
In contrast, in partial tetraplegia paralysis of the hands and fingers occurs, but the movement of the arms is maintained.
On the other hand, according to the American Association of Spinal Cord Injury (ASIA) can be classified the spinal cord injuries in five different groups:
- Complete spinal cord injury A : In this case, the person does not preserve his sensory or motor capacity below the level of the injury. It encompasses the sacral segments, thus also impairing the ability to control sphincters.
- Incomplete spinal cord injury B : In this case there is a certain preservation of the sensibility, while the motor capacity is limited below the level of the lesion.
- Incomplete spinal cord injury C : In this case the person preserves their sensitive ability and muscular control. However, the muscles are weak and considered non-functional.
- Incomplete spinal cord injury D : In this case the muscles below the neurological level are functional in 75%.
- Incomplete spinal cord injury E : In this case the lesion is minimal. The force and the sensitivity is practically in total normality.
Causes
Tetraplegia appears as a consequence of an injury to the cervical cord or peripheral structures. The main cause of this condition are injuries occurring right in the neck region. However, other conditions may also be related to quadriplegia. The main ones are:
- Syndrome of the anterior spinal artery
- Dislocation of the atloaxoid joint
- Malformation of Arnold Chiari
- Transverse myelitis
- Poliomyelitis
- Spina bifida
Treatment
At present, tetraplegia is considered an irreversible condition, so there are no interventions capable of treating this condition.
However, it is important that people with this condition perform intense rehabilitation programs to minimize the deterioration of movement.
References
- Coulet B, Allieu Y, Chammas M (August 2002). "Injured metamere and functional surgery of the tetraplegic upper limb."Clin Clin. 18 (3): 399-412, vi.
- Gorgey, Ashraf; Mather, Kieren; Cupp, Heather; Gater, David (January 2012). "Effects of Resistance Training on Adiposity and Metabolism After Spinal Cord Injury".Medicine & Science in Sports & Exercise. 44 (1) (Volume 44 (1)): 165-174.
- Spinal Cord Injury: Paraplegic & Quadriplegic, Tetraplegic Information". Apparelyzed.com: Spinal Cord Injury Peer Support. Retrieved24 April 2013.
- Spinal Cord Injury."American Association of Neurological Surgeons. May 2016. Retrieved February 4, 2017.