Tetraplegia, also known as quadriplegia means paralysis of the upper and lower limbs with pelvic structures in addition to it. This usually occurs as a result of injury to the brain or spinal cord which cut off information coming from the brain to the trunk and extremities. Tetraplegia is used in America whereas quadriplegic is the preferable term in Europe. There are other related terms which we will attempt to differentiate.
We have defined quadriplegia to mean paralysis of all the four limbs including the pelvic area. Paraplegia is used to refer to lower limb paralysis while hemiplegia refers to paralysis of a side of the body. Right hemiplegia means paralysis of the right side of the body while left hemiplegia denotes paralysis of the left part.
Tetraparesis, on the other hand, means weakness of all four limbs while hemiparesis refers to weakness of both lower limb which may be spastic or flaccid. Paresis is also caused by nerve damage but with some form of movement retained.
Tetraplegia is caused by injury to the spinal cord which can be due to trauma either from a motor vehicle accident, violent contact from the back or a fall on the back. It can also be caused by tumor primarily affecting the spinal cord or as a result of metastasis to the spinal cord. Infectious conditions like poliomyelitis and transverse myelitis can also to tetraplegia.
Spinal cord injury is classified as a complete or incomplete injury by the America Spinal Injury Association (ASIA). Complete spinal cord injury means there is a complete transection of the spinal cord whereas incomplete spinal cord injury only has the spinal cord partially transected.
There is a total loss of motor and sensory response below the injury site in complete spinal injury. ASIA classify spinal cord injury using an ASIA impairment scale which grade severity of damage with alphabet A to E.
- A: Complete; Loss of all forms of sensory and motor function below S4-S5 e.g central cord syndrome
- B: Incomplete; sensory function is retained while the motor function is lost below S4-S5. e.g Brown-Sequard syndrome
- C: Incomplete; Normal sensory, preserved muscle function with power grade less than 3 e.g Anterior cord syndrome
- D: Incomplete; Normal sensory function, preserved muscle function with power above 3. e.g Conus Medularis
- E: Norm; Normal motor and sensory function e.g cause equina.
Signs and symptoms
The signs and symptoms include the inability to use all the limbs and pelvic structures. A patient can present with urinary and fecal incontinence, the effects of which can be very profound on the patient psychological and physical health. Urinary retention and incontinence encourage the growth of infection which must be tackled head-on. There can also be a loss of sexual function in both sexes; men suffer erectile dysfunction while women may experience vaginal dryness due to decrease lubrication. It can also affect breathing and other autonomic functions.
Secondarily, there may be a development of pressure sore due to the immobility; pressure sore can lead to chronic leg ulcer which is very debilitating. The presentation can also be a loss of sensation or impaired sensation in affected areas, manifesting as numbness, reduced sensation or burning neuropathic pain. Symptoms are also dependent on the severity and extent of the injury.
It’s unfortunate that there is still no way to reverse damage to the spinal nerve. The goal of treatment is to prevent worsening conditions and assist the patient to live a productive life.
Patient with fecal and urinary incontinence are trained on how to have some form of control. In addition, antibiotics might be given in suspected cases of infection in patients with urinary incontinence.
The patient is enrolled for rehabilitation from the early stages of recovery. The management is usually multidisciplinarian involving orthopedic surgeon, neurologist, and physiotherapist with the attending nurses inclusive in the management plans.
Prognosis still remains poor, which is due to limited progress made in spinal nerve studies. There are, however, ongoing trials in spinal cord rewiring.