Caused by a lesion of the spinal cord, paraplegia corresponds to paralysis, that is to say the absence of movements, more or less complete of the two lower limbs and the lower part of the trunk. In three quarters of cases, the cause is traumatic. In addition to paralysis, paraplegia is associated with sensory, respiratory and control disorders of the urinary, intestinal and genito-sexual systems. The management of paraplegia rests first of all on the treatment of its cause and then on rehabilitation.

Paraplegia refers to paralysis, that is to say the absence of movement, more or less complete of the lower limbs and the lower part of the body. It is the consequence of an injury to the spinal cord. The degree of paraplegia depends mainly on the segment of the spinal cord that the pressure is exerted on and the duration of this pressure.

Paraplegia differs from:

• quadriplegia, where all four limbs are affected;
• hemiplegia, which is paralysis of half the body, left or right, caused by brain damage.

Nearly 50 people are paraplegic in France, and 000 out of 3 people with paraplegia are men.

Paraplegia is said to be:

• complete, when there is a total absence of sensitivity and motor skills below the lesion;
• incomplete, when there is persistence of sensitivity or voluntary motor skills below the lesion.

Paraplegia results, in almost 70% of cases, from a traumatic accident causing damage to the spinal cord:

• road accidents ;
• sports accidents;
• falls;
• shallow water diving;
• assaults (shooting), etc.

These accidents particularly affect young men.

In a quarter of cases, the cause of paraplegia is non-traumatic damage to the spinal cord:

• malignant (metastatic) or benign (hemangioma, neuroma, meningioma) tumors that compress the marrow;
• herniated discs (compression of the spinal cord by an intervertebral disc);
• significant spinal osteoarthritis (cervicarthrosis myelopathy at the cervical level);
• malformations such as syringomyelia;
• accident of anesthesia;
• spinal medullary infarction;
• ischemia of the spinal cord (oxygen deficiency);
• bleeding from the marrow;
• infection of an intervertebral disc (spondylolisthesis) or the covering around the marrow (epiduritis);
• inflammations, such as polio, Guillain Barré polyradiculoneuropathy or multiple sclerosis.

In this case, it is a so-called “medical” paraplegia.

Factors of psychological origin can also be at the origin of paraplegia.

The spinal cord is an extension of the brain. It acts as a transmitter, which routes stimuli from the brain to the muscles and transmits to the brain information relating to the position of the limbs, sensitivity to temperature or pain. When this nerve transmission is damaged, a combination of symptoms results that indicate paraplegia. This is characterized by paralysis, disorders of vegetative functions as well as a relaxation of tension and muscular reflexes.

So paraplegia does not only mean loss of motor skills. It can indeed be associated with disorders:

• sensitive: reduction or elimination of the sensitivity of the skin, causing the risk of lesions going unnoticed, the paraplegic person feeling little or no pain;
• control of the urinary (incontinence, retention), intestinal (transit disorders, constipation), genito-sexual (erectile dysfunction), respiratory systems: fragility or respiratory failure, more or less important.

Muscle contractures, especially when the paralysis is not complete, can be very troublesome.

The handicap is very variable depending on the level and severity of the damage to the spinal cord. Generally, paraplegic people retain a certain autonomy, after their rehabilitation, in a situation where the wheelchair is essential, this one being able to carry out independently:

• their transfers: to go from the armchair to the bed and vice versa, to go from the armchair to the toilet seat and vice versa;
• drive an adapted car;
• move inside and out;
• “Manage” their urinary problems themselves, and so on.

The management of paraplegia is characterized by various phases, each of which has a distinct objective.

Initial care

The initial management, known as the acute phase, aims to maintain vital functions. This involves stabilizing the patient by positioning and fixing the cervical, thoracic and lumbar vertebrae, in order to prevent the slipping of damaged vertebrae. This stabilization ensures that vital functions are protected.

Surgical intervention

Then, it is a question of stabilizing the patient via a surgical intervention:

• when the spinal cord is damaged too badly, no surgical intervention will be able to repair it;
• when the vertebrae are damaged, the purpose of the surgery is to stabilize the spine in order to prevent further damage such as a deformity of the spine, which can among other things lead to breathing problems;
• when paraplegia is caused by swelling in the spinal cord, the surgery is to remove the inflammation. This must be done very quickly, ie within three days of the accident.

In the case of bleeding from the spinal cord, certain drugs can increase the blood pressure. The purpose of this measure is to improve blood circulation in the damaged areas.

Medical care

Following stabilization of vital functions and surgical interventions, medical care is provided to patients. Paraplegics should be regularly rotated and moved to avoid pressure sores, especially since these can appear without the patient feeling pain. The aim here is to prevent muscle contracture and the formation of sores. In some patients, it may also be necessary to perform a catheterization to probe the bladder or bowel.

Rehabilitation phase

The next phase of the care consists of the rehabilitation of the paraplegic person, that is to say to teach him to live with his paraplegia, and in particular to move in a wheelchair. Rehabilitation methods thus aim to promote patient autonomy and facilitate their adaptation to their new situation. The patient can have recourse to physiotherapy and occupational therapy, two approaches through which he can train to maximize his ability to move. Physical activity contributes to the maintenance of muscle mass. When the nerves are not all affected, the patient can learn new movements and thus be able in particular to better control his movements in a wheelchair. Other approaches, such as aqua therapy and massage, can also be helpful. Among other things, they can help improve sensitivity and have a positive impact on physical constitution.