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96: PARAPLEGIA

Mollie Venglar, DSc, MSPT, NCS; Megan Samantha Rosga, DPT, MSPT, NCS

ICD-9-CM CODE

  • 344.1 Paraplegia

ICD-10-CM CODE

  • G82.20 Paraplegia, unspecified

PREFERRED PRACTICE PATTERN

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

PATIENT PRESENTATION

An 18-year-old male was injured on a motorbike he had received for his birthday. His friends dared the young man to jump the pond on the family property. In mid-jump he lost his hold on the bike, the bike fell into the pond, and he continued through the air. He landed on his back and was knocked unconscious. In the emergency department, radiographs revealed a complete dislocation of T4 on T5 with fractures of the bodies of T3, 4, 5 as well as the pedicles of T4 and laminae of T3, 5. Patient underwent surgical fixation with Harrington rods and was placed in a thoraco-lumbar stabilizing orthosis (TLSO). Prior to his injury he participated in high school football and basketball, he worked in the family business, and was planning to enter college in the fall. His past medical history was unremarkable. His injury is assessed as a T4, ASIA A (American Spinal Injury Association).

KEY FEATURES

Description

  • Complete paralysis of the trunk and bilateral lower extremities

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

Essentials of Diagnosis1

  • Complete neurological examination

    • 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 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 first lumbar vertebra (L1); damage at or above this level will produce upper motor neuron (UMN) signs and symptoms

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

General Considerations

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

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

Demographics

  • Men four times as likely as women

  • Most common cause is motor vehicle accident (MVA)

  • Second most common cause is falls

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • UMN signs present if the injury is above the conus medullaris

  • LMN signs present if the injury is in the conus medullaris or cauda equina

  • Complete ...

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