Quadriplegia, a condition involving the paralysis of all four limbs and the torso, results from an injury high on the spinal cord. Such an injury, typically within the cervical spine from vertebrae C1 to C7, disrupts nerve signals between the brain and the rest of the body. The higher the point of injury, the more extensive the paralysis and functional loss. While medical advancements have improved life expectancy, individuals with quadriplegia face specific health risks that require ongoing management.
Respiratory System Complications
A leading cause of mortality in individuals with quadriplegia is complications involving the respiratory system. Paralysis from a high spinal cord injury affects the muscles required for breathing, including the diaphragm and the intercostal muscles between the ribs. This muscular weakness compromises the ability to take deep breaths and diminishes the force of a cough, making it difficult to clear secretions from the lungs.
This impaired clearance creates an environment where pathogens can accumulate, leading to a heightened risk of pneumonia. Bacteria that would normally be expelled can multiply within the lungs, causing an infection that the body struggles to fight. This compromised respiratory function is a direct pathway to pneumonia, which remains a leading cause of death.
Cardiovascular Health Issues
The cardiovascular system is placed under considerable stress following a high-level spinal cord injury. The lack of mobility alters how the heart and circulatory system function. Over time, the heart muscle can decondition, which diminishes its efficiency and can contribute to various forms of heart disease.
A significant cardiovascular risk is the development of deep vein thrombosis (DVT). Due to the paralysis of leg muscles, which normally help pump blood toward the heart, blood can pool in the lower extremities. This stagnant blood is more likely to form clots. If a piece of this clot dislodges, it can travel to the lungs, causing a pulmonary embolism, which is often fatal.
For those with injuries in the upper cervical spine, a condition known as autonomic dysreflexia presents a risk. This condition involves a sudden, uncontrolled spike in blood pressure in response to a stimulus below the level of injury that the individual cannot feel, such as a full bladder. This hypertensive crisis can lead to stroke, seizure, or cardiac arrest if not managed immediately.
Infections and Sepsis
Sepsis, a severe body-wide infection, is another leading cause of death. These systemic infections often originate from localized issues that become gateways for bacteria to enter the bloodstream. One of the most common sources is pressure sores. These wounds develop when constant, unrelieved pressure on an area of skin, often over bony prominences, restricts blood flow and causes the tissue to break down.
An open pressure sore provides a direct entry point for bacteria. If the infection is not treated effectively, it can spread into the bloodstream, triggering sepsis. Sepsis is a medical emergency where the body’s inflammatory response to the infection can cause widespread organ damage and failure.
Another frequent source of infection is the urinary tract. Many individuals with quadriplegia require a catheter to manage bladder function, which can introduce bacteria. Urinary tract infections (UTIs) are common and can escalate if not promptly treated. A severe UTI can progress to a kidney infection and lead to sepsis.
Proactive Health Management and Prevention
Proactive and consistent management can mitigate many serious risks. Diligent respiratory care is important. This includes assisted coughing techniques, where a caregiver helps apply pressure to the abdomen to simulate a stronger cough, and regular breathing exercises to maintain lung capacity. These practices help clear secretions and reduce the likelihood of pneumonia.
Preventing skin breakdown is another focus of care. This involves frequent repositioning to relieve pressure and the use of specialized mattresses or cushions that redistribute body weight. Daily skin inspections are needed to identify any areas of redness or breakdown early, allowing for intervention before a serious sore can develop.
To address cardiovascular risks, strategies to prevent DVT are often employed, such as using compression stockings or pneumatic compression devices that help maintain blood flow. Careful monitoring of blood pressure is also important. Adherence to bladder and bowel management programs helps prevent UTIs, reducing the risk of infection and sepsis.