Key points
Tetraplegia is a serious movement disorder characterized by progressive or immediate loss of sensitivity and mobility of the limbs (both lower and upper). The inability to move or coordinate the limbs can be total or partial depending on the severity of the trauma suffered.
Causes
Tetraplegia is the result of spinal cord injury at the cervical spine. Factors predisposing to tetraplegia include: car accidents, violent falls, sports injuries, accidents at work and violent crimes.
Symptoms
The characteristic symptoms of tetraplegia depend on the cervical point where the trauma occurred and on the severity of the nerve injury. In general, the clinical picture of tetraplegia is characterized by: involuntary contraction of voluntary muscles, difficulty or inability to coordinate movement, respiratory deficits, numbness in the limbs, urinary and fecal incontinence, limb paralysis.
Diagnosis
In case of limb paralysis, diagnostic assessment is important to trace the cause. The most used investigative tests are: CT, MRI, radiographs, myelography and transcranial magnetic stimulation.
Therapy
There is no complete cure for tetraplegia. Currently, the administration of NSAIDs, muscle relaxants and corticosteroids can partially relieve pain and alleviate symptoms. When necessary, the patient undergoes specific surgical treatments.
Definition of tetraplegia
Among movement disorders, quadriplegia plays an important role. Due to a severe spinal cord injury at the cervical level, tetraplegia causes loss of sensation and muscle strength in the limbs (upper and lower). A serious trauma at the level of the first and second cervical vertebra leads instead to the death of the subject.
A little anatomy to understand ...
The cervical spine is composed of 7 vertebrae identified with the letter C, and progressively numbered from C1 to C7. The upper cervical spine consists of the atlas vertebrae (C1) and epistropheus (C2), while the lower portion is composed of the remaining 5 vertebrae (C3-C7).
A trauma to the spinal cord enclosed in the C1 and C2 vertebrae leads to the death of the victim. Injuries to the lower cervical spine are instead responsible for paralysis of the arms and legs (tetraplegia).
Tetraplagia is therefore a highly debilitating disease. Scientists are mobilizing to seek effective therapy or treatment in repairing spinal cord injuries; so much so that research aimed at this purpose is active all over the world. To date, corrective therapies are available, capable of correcting - although not totally restoring - minor bone marrow lesions, guaranteeing a fairly satisfactory quality of life for tetraplegia patients.
Causes
Tetraplegia is the immediate expression of a direct or indirect trauma to the spinal cord contained in the C3-C7 cervical vertebrae. If the lesion occurs at the dorsal or lumbar level, paraplegia is spoken of correctly.
The risk factors for tetraplegia are:
- Motor vehicle accidents → most spinal cord injuries are caused by road accidents with high-speed motor vehicles
- Violent falls
- Sports traumas (including football, horse riding, hockey and diving in shallow waters)
- Extreme sports traumas (eg motor boats, parachuting, jet skis)
- Accidents during work
- Gunshot wounds and cutting wounds (violent crimes)
In all the situations just listed, the spinal cord can undergo direct laceration (caused by that precise trauma) or indirect (due to bone chips, hematomas or fragments of glass / metal that, due to the accident, damage the bone) .
In some cases, a spine that is already weakened is more susceptible to trauma. For example, patients with rheumatoid arthritis, osteoporosis or spinal stenosis are particularly exposed to the risk of tetraplegia, even following minor traumatic events.
Tetraplegia can affect anyone. Despite what has been said, individuals between the ages of 15 and 35 are the most affected category. The mortality rate from quadriplegia tends to be higher in children with spinal injuries.
Cervical spinal cord trauma → nerve impulse interruption necessary for voluntary movement → limb paralysis (tetraplegia)
Tetraplegia due to brain injury
Tetraplegia due to brain injury deserves further investigation. Unlike the traumatic variant, tetraplegia due to brain injury (both during childhood and in adulthood) is due to extensive damage to the encephalic level, specifically in the areas of the brain responsible for control and voluntary mobility.
Patients suffering from this form of tetraplegia are completely non-self-sufficient and need permanent assistance to fulfill every need.
Symptoms
The symptoms of tetraplegia depend on the cervical point where the trauma occurred and, clearly, on the extent of the lesion.
It should be emphasized that spinal cord injuries can be partial (incomplete quadriplegia) or total (complete tetraplegia). In the first case, the traumatic injury allows the victim to maintain a certain sensitivity and partially control the movement governed by nerve impulses generated below the neurological level of the lesion. Complete tetraplegia instead determines the total immobility (articular paralysis) of the subject.
In general, the clinical picture of "classic" tetraplegia is characterized by:
- Uncontrolled contraction of voluntary muscles
- Difficulty / inability to control voluntary movements
- Breathing difficulty, caused by paralysis of the respiratory muscles
- Pain (when perceived)
- Numbness and progressive / immediate weakening of the limbs
- Loss / reduction of limb sensitivity
- Loss of ability to control anal and bladder sphincters: constipation / incontinence / bladder spasms
- NOTE: The severity of symptoms depends on the location and intensity of the trauma suffered
In particular, the symptoms of tetraplegia differ according to the location of the trauma. The table summarizes the symptoms derived from a general lesion at the level of the spinal cord (cervical area), differentiated according to the vertebrae involved in the trauma.
Cervical vertebra hit | Symptoms caused by the trauma |
C1-C2 | Severe trauma leads to the death of the subject |
C3 | Loss of diaphragm function |
C4 | Loss of biceps and shoulders function |
C5 | Inability to move or move biceps, shoulders, wrists and hands |
C6 | Limited control of wrist movement + complete loss of hand movement |
C7 | Limited control of the ability to move the upper limbs is permitted but the movement of the hands and fingers is denied |
Patients who have suffered a severe traumatic injury above the C7 vertebra are unable to handle normal daily activities.
In addition to the symptoms described above, it is not uncommon to also find further prodromes, such as: altered heart rate, sweating, increased body temperature and blood pressure variations.
Diagnosis
A spinal cord injury is a clinical emergency in all respects. The medical team proceeds with a thorough physical examination associated with neurological tests.
The diagnosis of quadriplegia relies mainly on the use of:
- Imaging tests (CT, MRI, radiographs)
- Myelography: it is a radiological test of the spinal cord and of the meningeal membranes, consisting in the injection of a contrast medium to identify any pathological affections affecting the marrow
- Transcranial magnetic stimulation: non-invasive diagnostic technique that allows to evaluate the health status of neuronal circuits within the Central Nervous System (CNS)
The results of these tests allow to identify the exact position of the trauma and the severity of the tetraplegia.
Therapy
To date there is still no complete cure for tetraplegia. However, scholars are mobilizing towards innovative therapies based on CNS regeneration systems using stem cells. Only by restoring the structural and functional integrity of the injured marrow could the patient regain full control of sensitivity and joint movements.
However, patients with tetraplegia can be treated according to different strategies. We recall that in addition to the violence of the lesion, the time elapsed between the moment of trauma and the beginning of therapy is essential to determine the patient's prognosis.
The treatment options currently available for traumatic injuries to the cervical spine are:
- Administration of corticosteroids to reduce swelling, since the edema could damage the spinal cord and cause tetraplegia
- Administration of NSAIDs and muscle relaxants to relieve pain
- Botox injections, indicated to reduce muscle spasticity
- Surgery, aimed at removing liquids, tissues or bone fragments that press on the spinal cord
- Spinal traction (when possible): allows and facilitates the movement of the spine
- Physical, occupational and rehabilitative therapy: useful for dealing with disability caused by tetraplegia
