TETRAPLEGIA: CHARACTERISTICS, SYMPTOMS, TYPES AND TREATMENTS - MEDICINE - 2025

The tetraplegia or quadriplegia is a sign that is characterized by the total or partial paralysis of upper and lower extremities. This alteration occurs due to an injury to the spinal cord. Specifically, damage to some of the first thoracic vertebrae can cause tetraplegia.

Quadriplegia usually affects the spinal and cervical nerves and, in addition to causing paralysis in the four extremities of the body, it can also affect other regions such as the abdomen or chest, causing breathing difficulties.

Quadriplegia can affect everyone, including the late actor Christopher Reeve

The main causes that can give rise to these signs are trauma suffered in serious accidents and certain pathologies such as transverse myelitis, poliomyelitis or spina bifida.

Likewise, tetraplegia is usually associated with several complications secondary to the paralysis that it causes, such as the risk of infection, reduced mobility, pressure ulcers or involuntary control of the bladder and bowel.

In this article the main characteristics of this condition are postulated. The signs, symptoms and causes of tetraplegia are reviewed and the interventions to be carried out in individuals suffering from this type of injury are discussed.

Characteristics of tetraplegia

Tetraplegia is a condition that occurs when the person suffers an injury to the spinal cord above the first thoracic vertebra. This injury is characterized by affecting the cervical spinal nerves and generates a total or partial paralysis of the arms and legs.

In this sense, it is determined that a person suffers from tetraplegia when he is unable to move his lower and upper extremities due to damage to the cervical vertebrae of the spinal cord.

In general, individuals with tetraplegia are unable to regain their ability to move, which is why it is considered a condition that is usually chronic.

However, in some rare cases, the person can regain some movement through intensive rehabilitation.

Although paralysis of the arms and legs is the pathognomonic attribute of this medullary sign, tetraplegia can cause other symptoms such as weakening of the muscles of the abdomen and chest.

This factor, together with movement paralysis, is often associated with several of the complications that can result from quadriplegia.

People with this condition are often at high risk of developing an infection, have long and frequent hospitalizations, suffer from alterations in sensation and experience a deterioration in their respiratory function.

Quadriplegia and spinal cord injury

Damage to the spinal cord is often highly complex conditions. Each injury is different since it can damage different regions of the spinal cord, which is why they usually cause different signs and symptoms.

Of all spinal cord injuries, tetraplegia is probably the most serious and difficult type of cervical injury to rehabilitate.

The spinal cord is a channel that runs through the spinal column from the encephalic areas to the lumbar regions. The main objective of this structure is to transmit nerve impulses from the brain to the extremities of the body.

In this sense, the more intense the injury, that is, the more damage is produced in the spinal cord, the more complicated the treatment of tetraplegia will be.

At present, there is a high consensus in stating that cervical trauma are chronic conditions, so that quadriplegia would be an irreversible condition.

However, research is advancing in search of solutions to regenerate spinal cord injuries, mainly through the application of stem cells. This line of study postulates the possibility of, in the future, finding therapeutic tools to intervene in pathological conditions such as tetraplegia.

Injury causing tetraplegia

Lesions that cause tetraplegia are characterized by affecting a specific area of ​​the spinal cord. Specifically, this sign arises when any of the first seven vertebrae of the spinal cord are damaged, which are known as cervical vertebrae.

In this sense, tetraplegia develops due to an injury in the upper region of the spinal cord, that is, in one of the vertebrae located in the neck area.

The seven cervical vertebrae of the spinal cord are named by the letter C and the corresponding number. The vertebra closest to the brain is called C1, the next C2, the third C3, the fourth C4, the fifth C5, the sixth C6 and the seventh C7.

The specific study of each of the cervical vertebrae of the spinal cord has made it possible to determine what type of signs can be suffered when injuries occur in each of them. The main ones are:

1. Injuries to vertebrae higher than C4 can cause total or partial dysfunction of the person's respiratory capacity.
2. Injuries to the C5 vertebra usually cause paralysis of the hands and fists, but do not usually affect the shoulders and biceps of the upper extremities.
3. Injuries to the C6 vertebra cause a total loss of function in the hand but allow control over the fist to be maintained.
4. Injuries to the C7 vertebra cause dexterity problems and cause paralysis in the hand and fingers, but do not affect the ability to stretch the arm.

As can be seen, any injury to the cervical vertebrae of the spinal cord can cause tetraplegia, but each of them will generate a different clinical picture.

In addition, it must be taken into account that injuries to the spinal cord do not usually damage a single vertebra, but it is usually common to affect more than one.

Thus, tetraplegia is defined as an alteration that is characterized by affecting the cervical vertebrae of the spinal cord and causing total or partial paralysis of the movement capacity of the limbs of the person.

Signs and symptoms

In general, injuries that affect the upper cervical vertebrae of the spinal cord generate the typical paralysis of tetraplegia. In contrast, injury to the lower vertebrae can generate a minor alteration.

In this sense, the symptoms of quadriplegia may vary slightly in each case. For example, a person with this condition may have paralysis in the arms and legs, as well as severe breathing difficulties. In contrast, another individual with quadriplegia may have only leg paralysis.

As has been commented, the symptoms of this alteration depend mainly on the injured cervical vertebrae. Any of the following signs can be associated with tetraplegia:

1. Total or partial paralysis in the arms.
2. Total or partial paralysis in the legs.
3. Total or partial paralysis in the hands.
4. Depression or breathing difficulties.
5. Loss of dexterity or motor difficulties.
6. Inability to balance or walk.
7. Experimentation of involuntary and uncontrollable movements.

Types

Although each case of tetraplegia can present different forms, currently two main types have been classified: total tetraplegia and partial tetraplegia.

Total quadriplegia is characterized by causing a total paralysis in the four extremities of the body, so the person loses all ability to move. In contrast, in partial tetraplegia there is paralysis of the hands and fingers, but the ability to move the arms is maintained.

On the other hand, according to the American Spinal Injury Association (ASIA), spinal cord injuries can be classified into five different groups:

Complete spinal cord injury A

In this case, the person does not preserve his sensory or motor capacity below the level of the injury. It encompasses the sacral segments, so sphincter control ability also deteriorates.

Incomplete spinal cord injury B

In this case there is a certain preservation of sensitivity, while motor capacity is limited below the level of the injury.

Incomplete spinal cord injury C

In this case the person preserves his sensitive capacity and his muscular control. However, the muscles are weak and considered non-functional.

Incomplete spinal cord injury D

In this case the muscles below the neurological level are functional in 75%.

Incomplete spinal cord injury E

In this case the injury is minimal. The strength and sensitivity is practically in total normality.

Causes

Tetraplegia appears as a consequence of an injury to the cervical cord or peripheral structures. The main cause of this condition is trauma that occurs right in the neck region. However, other conditions can also be related to quadriplegia. The main ones are:

1. Anterior spinal artery syndrome
2. Dislocation of the atloaxial joint
3. Arnold Chiari malformation
4. Transverse meillitis
5. Poliomyelitis
6. Spina bifida

Treatment

Currently, quadriplegia is considered an irreversible condition, so there are no interventions capable of treating this condition.

However, it is important that people with this condition undergo intensive rehabilitation programs to minimize movement impairment.

References

1. Coulet B, Allieu Y, Chammas M (August 2002). "Injured metamere and functional surgery of the tetraplegic upper limb." Hand Clin. 18 (3): 399–412, vi.
2. Gorgey, Ashraf; Mather, Kieren; Cupp, Heather; Gater, David (January 2012). "Effects of Resistance Training on Adiposity and Metabolism After Spinal Cord Injury." Medicine & Science in Sports & Exercise. 44 (1) (Volume 44 (1)): 165–174.
3. Spinal Cord Injury: Paraplegic & Quadriplegic, Tetraplegic Information '. Apparelyzed.com: Spinal Cord Injury Peer Support. Retrieved 24 April 2013.
4. Spinal Cord Injury. ”American Association of Neurological Surgeons. May 2016. Retrieved February 4, 2017.