Tetraplegia

Injury at a high level like at the level of the cervical spine leading to injury to an injury to the spinal cord.

Common causes of this type of injury are trauma (car crash, gunshot, knife wound, sports injury) or diseases (polio, spina bifida or transverse myelitis).

Some other non traumatic cases may include arthritis, problems of blood vessels, cancer, inflammation, infection or deterioration of the spinal disc.

The nerve injuries may be cervical (in the neck), thoracic or lumbar (in the lower back).

Cervical injuries cause breathing problems and affect upper and lower limbs. The thoracic or lumbar injuries involve leg, bowel, bladder and sexual functions.

When there is an injury the nerves in that area get affected due to injury. The muscles and the nerves below the injured area also get affected due to injury to nerves in the injured area.

Older adults, being men, activities like sports and predisposing conditions like arthritis and osteoporosis are the risk factors for quadriplegia.

People with complete injury have total or almost total loss of sensation and movement below the injured area.
Symptoms of spinal cord injury are loss of movement, bladder or bowel control; loss of sensation like heat, cold and touch; exaggerated reflux activities or spasm; problems in breathing, coughing and clearing secretions; pain and intense stinging sensation and altered sexual sensitivity, sexual function and fertility.

Emergency symptoms are weakness, lack of coordination or paralysis in any part of the body, tingling, numbness or loss of sensation in body extremities; loss of control over bowel or bladder; problems in walking and balancing; breathing problem due to injury; abnormal posture or twisting of neck or back; extreme pain or pressure in neck, back or head and fading in and out of consciousness.

If there is neck pain, partial consciousness and signs of neurological damage or weakness then diagnostic tests are done on emergency basis. The tests done are X-ray, Computerized tomography (CT scan), Magnetic resonance imaging (MRI) and Myelography.

The damage caused to the spinal cord can not be cured. Treatment is given to prevent additional injury and help the patient to have productive and active life in the limit of the disability. Therefore treatment needs to be given without delay and it should be continuing further.

Immobilizing the spine is very important in treatment of quadriplegia. Traction may be applied for this purpose. With this corticosteroid may be given. After few days of treatment the tests are done to find out the severity of injury and the extent of recovery that is possible.

Surgery is also done if required. It may be done immediately after the accident (emergency surgery to remove bone pieces, herniated discs, broken vertebrae or foreign objects, which are compressing the spine) or later on after the swelling and trauma subsides.

Long term care is required to avoid complications like urinary infections, bed sores, etc. Rehabilitation is required to improve the strength of other muscles and restore mobility and independence to maximum achievable level.

Further medications are given as per the requirement like medications for bowel control, antibiotics for urinary tract infections, etc.

Modern technologies help the patient to be mobile and do the routine activities like modern wheelchairs, computer driven tools and gadgets, electrical stimulation devices and neural prostheses.

The prognosis depends on the extent of damage caused. The recovery starts from a week after the injury up to one to two years.

Complications include problems with urinary bladder and bowel movements; pressure sores; autonomic dysreflexia, breathing and lung problems, deep vain thrombosis and pulmonary embolism; weight control problems, spasticity and sexual dysfunction. Pain due to over using of muscles in a part of the body (due to impairment of other part) and new injuries due to accidents (due to lack of sensation) are common.

Avoiding accidents and falls and following safety precautions in sports activities can prevent quadriplegia.