Paraplegia involves paralysis that primarily affects the lower half of the body, including the legs and sometimes the abdomen. Individuals living with paraplegia often experience a reduced life expectancy compared to the general population. This article explores the primary medical and physiological factors that contribute to this reality.
Understanding the Core Impact of Paraplegia
A spinal cord injury leading to paraplegia fundamentally alters several bodily functions. Individuals experience a loss of voluntary motor control and sensation below the injury level, impacting their ability to move their legs and feet.
Beyond motor and sensory changes, paraplegia significantly impacts the autonomic nervous system. This system controls involuntary functions like blood pressure regulation, temperature control, and bladder and bowel function. Damage to the spinal cord leads to dysregulation of various organs such as the heart, lungs, kidneys, and bladder.
The consequences of immobility are also far-reaching. Reduced movement can lead to muscle atrophy and decreased bone density. The slowing of blood flow due to prolonged bed rest or limited leg movement can also contribute to the formation of blood clots.
Major Life-Threatening Medical Complications
Cardiovascular Disease
Individuals with paraplegia face an increased risk of cardiovascular disease, including heart disease and stroke. Autonomic dysfunction, particularly in injuries at or above the T6 spinal level, can lead to an imbalance in the nervous system’s control over the heart and blood vessels. This can result in issues such as low resting blood pressure and an increased risk of atherosclerosis.
Immobility also significantly raises the risk of deep vein thrombosis (DVT). These clots can dislodge and travel to the lungs, causing a pulmonary embolism (PE). A blood clot reaching the brain can also lead to a stroke.
Urinary Tract and Kidney Problems
Chronic urinary tract infections (UTIs) are common in individuals with paraplegia due to neurogenic bladder. This often leads to urinary stasis and necessitates catheterization for bladder emptying. The introduction of catheters can introduce microorganisms, increasing the risk of infection.
Untreated or recurrent UTIs can progress to severe kidney damage and eventually kidney failure. Urine retained in the bladder can back up into the kidneys, leading to hydronephrosis. This persistent infection and inflammation place a significant burden on the renal system over time.
Respiratory Illnesses
Respiratory complications are frequent following spinal cord injury, with the severity often determined by the level of the injury. Weakness or paralysis of respiratory muscles impairs lung capacity and the ability to cough effectively. This leads to a buildup of secretions, increasing susceptibility to respiratory infections like pneumonia and bronchitis.
Aspiration pneumonia is also a concern. The reduced ability to clear airways makes these infections more persistent and can lead to conditions like atelectasis.
Pressure Injuries and Sepsis
Chronic pressure ulcers, also known as bedsores, are common in individuals with paraplegia due to impaired sensation and limited mobility. Sustained pressure on bony areas disrupts blood flow. Because sensation is impaired, individuals may not feel the discomfort that normally prompts repositioning, allowing ulcers to develop and worsen.
These open wounds are highly susceptible to infection, leading to sepsis. Sepsis is a severe, life-threatening response to infection that can cause organ damage and septic shock. Pressure injuries are a significant source of systemic infections and are a direct cause of death in some individuals with paraplegia.
Autonomic Dysreflexia
Autonomic dysreflexia is a serious condition that can occur in individuals with spinal cord injuries at or above the T6 level. It involves an exaggerated, uncontrolled reflex sympathetic response to a noxious stimulus below the level of injury. Common triggers include a full bladder, urinary tract infection, or bowel impaction.
This overreaction causes a sudden and dangerous rise in blood pressure. If not promptly addressed, this can lead to severe complications such as cerebral hemorrhage (stroke), seizures, and even death.
Metabolic Disorders
Individuals with paraplegia have an increased risk of developing metabolic disorders such as type 2 diabetes and obesity. Reduced physical activity and changes in metabolism contribute to insulin resistance, leading to elevated blood sugar levels.
Obesity is also prevalent and contributes to a higher burden of cardiovascular issues. These metabolic changes further exacerbate the risk of heart disease.
Interplay of Factors Affecting Longevity
The various medical conditions described often do not occur in isolation but rather interact, creating a cumulative burden on the body. An individual with paraplegia might experience chronic UTIs that contribute to kidney problems, while also managing cardiovascular issues and pressure ulcers. This combination of multiple chronic conditions can significantly worsen overall health and increase susceptibility to severe outcomes.
Detecting medical issues early can be challenging due to impaired sensation. Individuals may not feel pain or other typical symptoms, leading to delayed diagnosis and treatment. This lack of protective sensation means conditions like pressure ulcers or internal infections might go unnoticed until they become advanced.
Chronic pain and persistent fatigue are common experiences for individuals with spinal cord injuries. These symptoms can lead to reduced physical activity and negatively impact mood, including an increased risk of depression. Such challenges can indirectly affect adherence to health management routines, increasing vulnerability to serious medical complications that contribute to reduced longevity.