paraplegias

Paraplegia refers to impairment in motor and/or sensory function of the lower limbs and trunk due to damage to the spinal cord below the cervical level, typically thoracic or lumbar segments. It is distinguished from tetraplegia (quadriplegia), which involves all four limbs. Paraplegia can be complete, with total loss of function below the level of injury, or incomplete, with varying preserved function.

Causes include traumatic spinal cord injury (such as car accidents and falls) and non-traumatic conditions (degenerative stenosis, tumors, infections like abscess or syringomyelia, inflammatory myelopathies, vascular insults). The level and severity of the injury determine the extent of symptoms.

Symptoms commonly involve weakness or paralysis of both legs, altered or lost sensation below the injury, and bladder and bowel dysfunction. Spasticity is common in many spinal injuries; chronic pain and disturbances in temperature or proprioception may also occur.

Diagnosis relies on a combination of history, neurologic examination, and imaging. Magnetic resonance imaging (MRI) is the preferred test to visualize the spinal cord and surrounding structures; computed tomography (CT) and X-rays assess bone injuries. Classification often uses the ASIA impairment scale to describe the level and completeness of the injury.

Management focuses on preventing further injury and promoting rehabilitation. Acute care may involve stabilization, surgical decompression if indicated, and, in some guidelines, limited use of corticosteroids, though routine use remains debated. Rehabilitation includes physical therapy, mobility aids and orthotics, wheelchair training, and coordinated bowel and bladder management, along with measures to prevent complications such as pressure ulcers.

Prognosis varies with the level and completeness of the injury. Complete paraplegia generally offers limited recovery, while incomplete injuries may improve with early and ongoing rehabilitation. Long-term care is typically multidisciplinary and individualized.

Epidemiology reflects diverse etiologies across all ages, with traumatic causes more common in younger adults and non-traumatic causes more prevalent in older individuals.