paraplegie

Paraplegia is a neurological condition characterized by partial or complete paralysis of the lower limbs and lower spinal cord. The term derives from Greek roots meaning “paralysis of the legs.” It is typically caused by damage to the spinal cord between the lower thoracic and upper lumbar levels, though other injuries such as lumbar disc herniation or spinal tumors can also result in similar deficits. Traumatic injuries are the most common cause, including motor vehicle accidents, falls, and sports injuries. Non‑traumatic causes encompass vascular events (e.g., spinal cord ischemia), infections (e.g., tuberculosis, spinal epididymitis), and inflammatory conditions (e.g., multiple sclerosis, transverse myelitis).

Clinical presentation varies depending on the level and completeness of the lesion. Patients generally experience sensory loss below the lesion, motor weakness or loss of voluntary control in the legs, and impaired bladder and bowel function. Autonomic dysfunction can lead to altered blood pressure regulation and loss of sexual function. The American Spinal Injury Association (ASIA) impairment scale classifies paraplegia from incomplete to complete injury, influencing prognosis and management.

Diagnostic evaluation begins with imaging—magnetic resonance imaging (MRI) provides the most detailed assessment of spinal cord integrity, while computed tomography (CT) scans are useful for bony fragmentation. Neurological examination determines the extent of motor and sensory deficits. Electrophysiological studies, such as somatosensory evoked potentials, may complement imaging findings.

Treatment is multidisciplinary. Early stabilization with surgical decompression and instrumentation improves neurologic recovery in many cases. Rehabilitation focuses on maximizing functional independence, preventing pressure ulcers, and training adaptive techniques. Pharmacologic interventions include high‑dose steroids in the acute phase for certain injury types; however, their use remains controversial. Long‑term management addresses secondary complications such as spasticity, urinary tract infections, and osteoporosis, and involves physiotherapy, occupational therapy, and psychosocial support.

Prognosis depends on initial injury severity, age, and comorbidities. Recovery is more likely after incomplete injuries and with prompt, comprehensive care. Paraplegia imposes significant physical, emotional, and societal challenges, requiring coordinated support from healthcare providers, family, and community resources.