Quadriplegia, also called quadriplegia, is a state of paralysis that affects all four limbs of the body. It is called “incomplete” if the spinal cord injury is not total and “complete” in the event of a total absence of motor skills.
“Quadriplegia is defined by paralysis of all four limbs caused by spinal cord injury (medullary)“, immediately defines Dr Laura Terrier, neurosurgeon. The damage affects the spinal cord and the transmission of the nerve impulse no longer takes place at the level of the nerve roots located below the lesion. It causes a major disability, the person becoming dependent for many actions of daily life.
What is complete quadriplegia? Incomplete ?
A distinction is made between complete and incomplete quadriplegia. “We are talking about complete quadriplegia in the complete absence of sensitivity and motor skills below the spinal cord injuryand quadriplegia incomplete (tetraparesis) in the event of persistence of sensitivity and/or voluntary motor skills below the lesion, especially in the perineal area“, explains Dr Laura Terrier, Neurosurgeon. Quadriplegia is usually caused by a lesion located above the first dorsal vertebratherefore a cervical lesion.
What is flaccid quadriplegia?
“Flaccid quadriplegia is defined by paralysis not associated with spasticity“, replies the doctor.
What is spastic quadriplegia?
“Spastic quadriplegia is characterized by paralysis associated with spasticitythat’s to say stiffness and excessive, involuntary muscle contraction“.
What are the differences between paraplegia and quadriplegia?
Depending on the location of the central nervous system lesion, we will speak of:
► The quadriplegia (or quadriplegia): “it is a paralysis of all four limbs due to a spinal cord injury (at the level of the cervical vertebrae)”, says Dr. Terrier.
► “There paraplegia concerns paralysis of both lower limbs due to spinal cord injury (at the level of the thoracic and lumbar vertebrae)“
► Finally, hemiplegia is a paralysis of half the body (upper and lower limbs) due to a contralateral brain injury.
What are the symptoms of quadriplegia?
“Symptoms are located below the spinal cord injurye, confirms our interlocutor.
► Symptoms engines : reduction or loss of motor skills (loss of walking and standing, moving in a wheelchair), muscle spasms or contractures especially when the paralysis is not complete.
► Symptoms sensitive : decrease or loss of skin sensitivity;
► The pain ;
► Symptoms respiratory (related to paralysis of the respiratory muscles): they can range from simple respiratory discomfort to respiratory failure which becomes very important in very high lesions (neck) in which the diaphragm is paralyzed;
► Symptoms digestive : intestinal transit disorders, constipation, diarrhea, etc.
► Symptoms urinary : urinary incontinence or on the contrary urinary retention
► Symptoms sexual : erection and ejaculation disorder, frigidity, etc.
Paralysis is responsible for a major disability with a loss of autonomy for all actions of daily life. “Long-term complications linked to the disability can occur. They are of order:
- Uro-digestives : urinary infections, kidney and bladder stones, intestinal obstructions
- Cardiovascular : phlebitis and pulmonary embolism
- Bony : fractures, deformations
- Dermal : bedsores
What are the causes of quadriplegia?
Quadriplegia is caused by a spinal cord injury “essentially a fracture of one or more cervical vertebrae which impacts the spinal cord”explains Dr Bertrand Debono, Neurosurgeon, President of the French Society of Liberal Neurosurgeons (SFNCL). The spinal cord is located in the canal formed by the spinal column. It is the structure from which all the nerves which control motor skills and sensitivity but also other functions such as sphincter control originate. The spinal cord injury thus leads to a cut in the transmission of nerve impulses at the level of the nerve roots located below. In more than half of cases, the injury is caused by trauma including road accidents and sports, particularly vertebral fractures leading to spinal cord severing. “Quadriplegia is most often linked to a traumatic injury. Road accidents are involved in 60% of cases, with a clear predominance of men (around 75%), and young people (47% of quadriplegic patients are under 25 years old and 70% under 35 years old). adds Dr Dobono. But domestic and sporting accidents (falling on skis, on horseback, while climbing…) are also in question. In other cases, the causes may be:
- Degenerative (cervical disc herniation, cervico-arthritic myelopathy)
- Infectious (tuberculosis)
- Inflammatory (Guillain Barré syndrome, multiple sclerosis)
- Vascular (thrombosis)
- Malformative and tumoral
What are the consequences of quadriplegia?
“Quadriplegia results in loss of voluntary use of the four limbs, the 2 legs and the 2 arms“The consequences depend on the location and extent of the injury.”When the lesion is at the level of the first cervical vertebra, the risk is paralysis of all four limbs and respiratory damage, that is, the patient is at risk of being ventilator dependent. When the lesion is at the level of the last cervical vertebra, paralysis may affect the lower limbs.
“The diagnosis of quadriplegia is clinicaladds Dr. Terrier. It can be confirmed by the demonstration of a spinal cord lesion on a MRI (magnetic resonance imaging)”.
Can quadriplegia be treated?
There is no treatment to repair the spinal cord and cure quadriplegia
Treatment of the cause, i.e. spinal cord injury, is complex and may be medical or surgical. “The prognosis depends on the level of injury and the speed of treatment. THE surgical treatment consists of decompress the spinal cord and/or fix unstable vertebrae (osteosynthesis or arthrodesis),” concludes the specialist. Currently, in cases of complete quadriplegia, there is no treatment to repair the spinal cord and cure the quadriplegia. Treatment of the consequences, the disability, is essential. “The person becoming dependent for all actions of daily life“. Multidisciplinary care (doctors, nurses, physiotherapists, occupational therapists, social workers and clinical psychologists) is then possible. “Its objectives are to relieve symptoms, optimize recovery and improve autonomy patients, particularly in the actions of daily life. It is based on the re-educationprevention and treatment associated complications (uro-digestive, cardiovascular, bone, skin).
Where to ask for help?
Please note that it is possible to make a request to the MDPH (Departmental House for Disabled Persons) in your department of residence in order to have your disability recognized and to benefit from rights and assistance (social worker, assistance with residence…)“In quadriplegia, independence is often more precarious or even impossible for many essential actions, recalls the APF France handicap site. Often, help from a third party is then necessary in everyday activities as well as in essential care (urinary and intestinal problems, prevention of wounds – bedsores – of the skin due to immobility and non-perception of pain, etc.).
What is the life expectancy of a quadriplegic?
The life expectancy of people with quadriplegia is lower than that of the general population by 10 to 20 years, according to studies, depending on the level of impairment. A French study established that these people have a risk of death more than twice that of the population. This reduction in life expectancy is linked to complications (respiratory, infectious including urinary, bedsores, etc.) but many quadriplegics live a very long time at the cost of daily prevention efforts. It is not a progressive disease.
Thanks to Dr Laura Terrier, Neurosurgeon at Rouen University Hospital and Dr Bertrand Debono, Neurosurgeon, President of the French Society of Liberal Neurosurgeons (SFNCL)