Spinal Cord Injuries and Paraplegia: Permanent Injuries and Outcomes

After sustaining a spine injury in an accident (for example an auto accident, construction site fall, motorcycle accident, or any other accident resulting in direct impact to the spine), questions arise as to the outcomes of these injuries. The main question is: will paralysis occur? The person who sustains such injuries may be initially unable to understand what's occurring as their medical situation takes precedent. However, family members want answers, and they want them quickly! What common questions do family members usually have? And what are some less common but equally important ones? This article serves to compile information relating to all facets of spinal cord injury (SCI) as it pertains to personal injury accidents.

Where is a spinal cord injury located?

Immediately following an accident resulting in what paramedics presume is paralysis of any kind, the patient will receive stabilization and transport to a hospital. Receiving stabilization means a neck brace (“c collar”, a cervical spine stabilizing device) is used to ensure the victim cannot accidentally move their head and neck, causing further injury to themselves. Upon arrival to a hospital, CT scans can point doctors to the source of the injury quickly. There are several places where injuries that cause paralysis can occur:

• The Cervical Spine. Numbered C1-C7, this portion of the spine contains the vertebrae that form the neck.
• The Thoracic Spine. Numbered T1-T12, these vertebrae form the upper back.
• The Lumbar Spine. Numbered L1-L5, these vertebrae sit near the base of the spine. To further expand on the lumbar spine's extent, the spinal cord itself ends near the L1 or L2 vertebra depending on the height of the patient.
• The Sacral Spine. Numbered S1-S5, this is the very end of the spinal column, but the spinal cord itself does not reach this region. Instead, the sacral spine contains spinal nerves.

The higher up on the spine (Cervical Spine region) the injury occurs, the more severe resulting paralysis will be. For example, an injury occurring at the C4 region of the spine will result in total paralysis (tetraplegia) from the shoulders down.

What are the differences between Quadriplegia, Tetraplegia, and Paraplegia?

Depending on the extent of injury, a patient will receive either a diagnosis of Tetraplegia or Paraplegia. These diagnoses have separate definitions, and the family of the patient will want to know which their loved one has sustained, as will the patient when the time comes for them to have discussions with their doctors on the future of their medical care.

Tetraplegia. The easiest way to explain Tetraplegia to concerned family members is that it's a form of paralysis affecting both arms and both legs, all the extremities. The word Quadriplegia is another way of referring to Tetraplegia. Officially, when doctors document a patient's diagnosis for medical records, the word Tetraplegia is used.

A person who sustains paralysis to all four extremities is referred to as tetraplegic during trial.

Paraplegia. The medical definition of paraplegia is “a form of paralysis that affects both legs”. In cases where only one leg is affected, this type of paralysis is referred to as monoplegia. Monoplegia can affect any of the patient's four limbs. (“Monoplegia of the leg” or “monoplegia of the arm”).

Tetraplegia is the most severe of the above conditions, as a person with paraplegia has use of their arms and can still perform some tasks independently while in a wheelchair or other assistive mobility device. Those who suffer tetraplegia cannot do anything independently. This is where a Life Care Plan becomes necessary. We address Life Care Plans and their necessity later in the article.

What happens when complications arise?

The spinal cord terminates just short of the lumbar region. It ends just below the waist; the spinal cord tapers off into a group of nerve roots ("cauda equina"). If a back injury is severe enough, it compresses these nerve bundles and emergency surgery may be necessary for decompression. This is often seen but not limited to disk herniations. Continue reading for a detailed introduction to "cauda equina".

Cauda equina syndrome

The American Association of Neurological Surgeons explains cauda equina syndrome (CES) as:

"[...]Cauda equina syndrome?(CES) occurs when the nerve roots of the?cauda equina?are compressed and disrupt motor and sensory function to the lower extremities and bladder. Patients with this?syndrome?are often admitted to the hospital as a medical emergency. CES can lead to incontinence and even permanent paralysis."

Symptoms of "cauda equina"

The following symptoms may occur when a spinal cord injury worsens:

???????Pain, weakness, muscle atrophy. in affected extremities

???????Bowel or bladder dysfunction. People who experience a level of paralysis with disk herniation may find bladder or bowel control is weak due to compression of nerve roots in the spine. Difficulty or inability to urinate may also be a symptom that requires emergency medical attention.

???????Saddle anesthesia. This phenomenon includes progressive loss of function and affects the areas of the body that one uses when sitting on a "saddle". These areas include inner thighs, area around the buttocks, and the backs of the legs.

Some patients experience all the symptoms while others will experience just one or two. Regardless, these symptoms indicate a severe medical issue and should be addressed by a medical professional to avoid further injury.

Why did this accident and resulting paralysis occur?

Spinal cord injuries remain one of the most frequent causes of paralysis as of 2022. There are many reasons why this injury may have afflicted a loved one, and the answer to this question is just as important as questions on the medical side.

The website SpinalCord ( www.spinalcord.com ) lists the common causes of SCI broken down into percentages based on how frequently each accident or injury results in tetraplegia or paraplegia:

·?????Vehicular Accidents (38.6%)

·?????Falls (32.2%)

·?????Acts of Violence (14%)

·?????Sports Injuries (7.8%)

·?????Medical/Surgical Injuries (4.2%)

·?????Other (3.2%)

While “Medical/Surgical Injuries” only makes up 4.2% of accidents resulting in a paralyzed patient, it's no less serious. In fact, medical errors resulting in a patient becoming paralyzed can be classified as medical malpractice and require a personal injury law firm consultation. If a patient sustains injuries because of another's negligence, in the case of medical and surgical errors, a doctor, legal action may be pursed on behalf of the patient by their family. Of course, if they feel able, the patient may consult with a personal injury lawyer on their own behalf!

What quality of life will remain mentally and physically for a patient who sustains an injury resulting in paralysis?

People with spinal cord injuries will lose quality of life. Unfortunately, this is a guarantee. Depending on the extent of the paralysis, a patient can lose some or all of their former independence. This can result in depression, frustration, anger, and hopelessness. Mental anguish because of becoming paralyzed after an accident is a lifelong recovery for victims who sustain injuries because of another's careless actions. Whether the person becomes injured as the result of an unsafe workplace, a drunk driver, or medical malpractice, the pain and suffering remain consistent.

Physically, a patient hospitalized for a tetraplegic injury undergoes multiple changes to their body. Chronic pain is the chief complaint of patients who become paralyzed after an accident. “How can this be?” you may ask. “I thought paralysis means a patient loses feeling in the affected extremities?” However, it's a myth that those who become paralyzed do not feel any pain. In fact, chronic pain develops due to muscle atrophy (loss of muscle tone and function from lack of use) in parts of the body that do not become paralyzed, as the patient can no longer utilize them. Atrophy, medically, means muscles become severely deconditioned and ultimately deteriorate. Nerve damage from the injury can also cause pain in parts of the body that remain able to be used.

Other physical changes a patient will undergo after an injury resulting in tetraplegia could be complete or partial loss of sensation, complete or partial loss of movement, and muscle spasticity.

In catastrophic cases involving tetraplegia, the injured party is unable to care for themselves at all and requires round-the-clock care. These personal injury clients will require a Life Care Plan.

What is a Life Care plan?

Losing the ability to care for oneself after an accident can result in the need for a Life Care Plan. So, what is a Life Care Plan and when does a person require one?

A Life Care Plan is exactly what it sounds like: a plan of care for a victim after sustaining a permanent injury such as paralysis or traumatic brain injury. The plan is created in coordination with a victim's lawyer and doctors. The two parties work together as a team to create a plan of care that will account for the costs of the patient's lifetime care. On the legal side, this ensures that a personal injury client will never have to endure financial hardship while undergoing medical care for their injuries.

A Life Care Plan is unique. No two plans are alike, because no two personal injury clients are alike. The Plan can include everything from a client's most basic needs such as mobility aides (wheelchair, walker, arm crutches) to more involved long term care needs such as a home health team or ADA and accessibility accommodations made to a client's home. If a wheelchair ramp is necessary for lifelong, safe access after paralysis, the Life Care Plan accounts for these needs. In cases of injuries in which paralysis or TBI occurs, a Life Care Plan will be in place prior to trial. The judge will consider every aspect of the plan when determining a verdict.

What should a victim and/or their family do after sustaining tetraplegia or paraplegia in an accident?

Physical pain and suffering, as well as permanent mental anguish is why it's important for those involved in accidents resulting in paralysis such as paraplegia and tetraplegia (as well as immediate family members acting as caregivers) to consult with a personal injury lawyer. The victim and/or their family should attempt to retain a personal injury law firm as soon as the victim is stable on the medical side.

Many personal injury lawyers will visit the hospital to consult with a family, if necessary, given the length of hospital stays for those who become paralyzed. This is only after a family reaches out to the law firm and requests a consultation. It’s never OK for a lawyer to show up at the hospital and attempt to persuade a family to take legal action without being asked to evaluate the case. Top personal injury lawyers all agree: a patient's physical well-being after an accident should always take precedent.