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ICD-9-CM Code

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  • 344.1 Paraplegia

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ICD-10-CM Code

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  • G82.20 Paraplegia, unspecified

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Preferred Practice Pattern1

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  • 5H: Impaired Motor Function, Peripheral Nerve Integrity, and Sensory Integrity Associated With Nonprogressive Disorders of the Spinal Cord

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Key Features

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Description

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  • Complete paralysis of the trunk and bilateral lower extremities

  • Result of damage to the spinal cord in the thoracic, lumbar, sacral spine or caudia equina

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Essentials of Diagnosis2

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  • Complete neurological exam

    • Muscle strength testing of the upper extremity (UE), lower extremity (LE), core musculature

    • Reflexes, deep tendon reflexes (DTRs)

    • Sensation

    • Coordination

    • Proprioception

  • Diagnosis is made by level of injury, severity of injury, and use of the American Spinal Injury Association (ASIA) assessment

  • Complete loss of sensory and motor function due to damage in the thoracic or lumbar spine

  • Paraparesis is the partial loss of sensory or motor function due to damage in the thoracic or lumbar spine

  • Commonly the result of trauma, but can also occur due to infarction or hemorrhage

  • Spinal cord ends at or near the 1st lumbar vertebra (L1); damage at or above this level will produce upper motor neuron signs and symptoms

  • Damage below L1 will produce lower motor neuron signs and symptoms

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General Considerations

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  • Damage to the spinal cord results in potential complications to many body systems

  • Be aware of wide range of complications in order to be safe and effective with patient care

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Demographics

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  • Men 4x as likely as women

  • Most common cause is motor vehicle accident (MVA)

  • Second most common cause is falls

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Clinical Findings

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Signs and Symptoms

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  • Upper motor neuron (UMN) signs present if the injury is above the conus medullaris

  • Lower motor neuron (LMN) signs present if the injury is in the conus medullaris or cauda equina

  • Complete injury is defined as no motor or sensory function spared in the lowest sacral segments

  • Incomplete injury is defined as partial or full function spared in the lowest sacral segments

  • Altered or lost trunk control and balance

  • Autonomic dysfunction if the injury is above the T6

  • Orthostatic hypotension

  • Loss of bone density

  • Decreased ventilatory capability for paraplegics with damage in the mid- to upper-thoracic region

  • Altered or lost ambulation/locomotion

  • Altered or lost bed mobility

  • Altered or lost transfer ability

  • Altered or lost muscle strength

  • Altered or lost sensations

  • Altered DTRs

  • Altered or lost bowel and bladder function

  • Altered or lost autonomic control

  • Altered blood pressure

  • Spasticity

  • Altered thermoregulation

  • Changes in muscle tone

  • Edema of legs, ankles, feet

    • Typically symmetrical and pitting in nature

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Functional Implications

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  • Impaired coordination

  • Impaired muscular strength

  • Impaired balance

  • Gait abnormalities

  • Impaired bed mobility

  • Impaired transfers

  • Decreased endurance and energy efficiency

  • Neuropathic pain

  • UE ...

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