Lumbar (The Lower Back)

Vertebrae L1-L5

There are five vertebrae and five pairs of spinal nerves in the lower back connecting to muscles in the thighs and legs.

Complete Paraplegia

Complete paraplegia is the result of an injury to the spinal cord anywhere below the neck. Damage will usually occur in the thoracic or lumbar region of the spine, and it has also been known to be caused by an injury to the lumbar/sacral regions too. The injury is classified by the region of the spine and vertebrae damaged, for example, if damage is caused to the third vertebra in the thoracic region, this would be known as T3 paraplegia.

The Effects of Complete Paraplegia

Paraplegia causes complete loss of movement and feeling in the legs, and is sometimes known to affect the torso but not the arms. The higher the level of injury, the more severe the loss of function and sensation.

If an injury occurs to the T1-T6 vertebrae, this will cause loss of function and sensation below mid-chest. This may result in: 

• Very little control of the torso
• Poor balance when sitting
• Dysfunctional bladder and bowel movements
• Loss of reproductive function

Injuries to the lower region of the thoracic region (T7-T12) will cause loss of function and sensation in the legs. The abdominal muscle will be preserved, meaning control of the torso and bodily functions will remain intact and balancing while sitting will still be possible.

The loss of function and sensation in the lower body caused by complete paraplegia can result in a number of further complications, which can be minimised by proper medical care and rehabilitation. Examples of complications include:

• Autonomic dysreflexia, which causes a person’s blood pressure to suddenly become excessively high
• Cardiovascular disease, which can increase the chances of heart attack, angina or stroke
• Chronic nerve pain, which can vary from a short stabbing pain to a prolonged pricking, tickling or burning sensation
• Deep vein thrombosis, which is the formation of a blood clot within a deep vein usually found in the legs
• Decreased fertility, which usually occurs in men
• Hyperthermia and hypothermia
• Osteoporosis, which is a condition where bones lose their strength making them more likely to break
• Pneumonia
• Skin deterioration or pressure sores
• Spasticity, which is a condition that causes muscles to be continuously contracted or spasm
• Neuropathic pain
• Urinary tract infections
• Psychological and psychiatric trauma as a result of the accident and injury
• Impaired sexual function and sensation, and sometimes reduced fertility in males some years post-injury

Rehabilitation after Complete Paraplegia

Somebody that suffers from complete paraplegia will be required to stay in hospital, usually in a spinal cord rehabilitation unit, for up to four to six months. Here, a programme of rehabilitation, skill-building and physiotherapy will be provided to help people adapt to the physical challenges in their day-to-day activities.

When a person is released from the hospital, they will usually be able to live independently with the ability to look after themselves, for example, eat, groom, bathe and dress. Most paraplegics will use a manual wheelchair to assist with mobility. 

Those with an incomplete injury who are capable of standing or walking with assistance for short periods of time may use braces, crutches or a walker to move about; although, this can take a great deal of strength and determination. Such ambulation may be useful indoors but walking long distances outdoors is likely to be limited as it is exhausting for the individual.

Anterior cord syndrome

Anterior cord syndrome is caused by an impact that damages the artery that runs along the front of the spinal cord. This is usually done by a fragment of a bone or a slipped disc. This injury causes loss of strength below the point of injury and loss of temperature and pain sensations. However, sensations, such as vibration and position awareness, are preserved and some movement may be able to be restored.

Central cord syndrome

This is an injury to the centre of the spinal cord that prevents the brain from sending information to the rest of the body. The main effects of central cord syndrome are loss of arm functionality and reduced functionality in the legs; however, it is occasionally possible to recover and gradually improve function in the legs if it is very incomplete. Bladder and bowel control can also be lost if damage is severe.   

Posterior cord syndrome

This rare syndrome is an injury to the artery at the back of the spinal cord that can cause difficulties in coordination and the loss of deep touch, vibration and position sensations. However, strength is preserved along with pain and temperature sensations. 

Brown-Sequard syndrome

This is a rare injury to one side of the spinal cord, which causes inverted complications. For instance, one side of the body below the region of the spine injured can completely lose movement but retain sensations of pain and temperature, while on the other side, the opposite is true.  

Cauda equina syndrome

This is an injury to the group of nerves at the base of the spine usually caused by trauma that compresses the nerves, resulting in back pain. Cauda equina syndrome can also result in partial or complete loss of movement and sensation, as well as bladder and bowel dysfunction. 

If the nerves have not been severely damaged, they may regrow, restoring some movement to the body.