From the Guidelines
Paraplegia at the T6 level requires immediate and long-term management to prevent complications, maximize independence, and improve quality of life, with a focus on maintaining mean arterial pressure (MAP) above 70 mmHg in the acute phase, as recommended by recent studies 1.
Management Overview
Paraplegia at the T6 level means there is a spinal cord injury at the sixth thoracic vertebra, resulting in paralysis and loss of sensation from the mid-chest down, affecting the lower trunk and legs while preserving upper body function. Key aspects of management include:
- Preventing complications such as pressure ulcers, neurogenic bladder, and bowel dysfunction
- Maximizing independence through physical therapy and rehabilitation
- Managing spasticity, neuropathic pain, and other associated conditions
- Providing psychological support for adjustment to paraplegia
Preventing Complications
To prevent pressure ulcers, regular pressure relief every 15-30 minutes is crucial, as the prevalence of pressure ulcers can reach 26% 1. Intermittent catheterization every 4-6 hours and bowel programs using stool softeners like docusate sodium and stimulants like bisacodyl on a consistent schedule are also essential.
Physical Therapy and Rehabilitation
Physical therapy should include range of motion exercises daily to prevent contractures and strengthening of upper body muscles to assist with transfers and wheelchair mobility. The Ile-de-France Regional Health Agency recommends a specific ratio of physiotherapists to patients for effective rehabilitation 1.
Medications and Support
Medications often include baclofen for spasticity, gabapentin for neuropathic pain, and prophylactic low-molecular-weight heparin during the acute phase to prevent blood clots. Psychological support is essential as adjustment to paraplegia often involves grief and identity changes.
Blood Pressure Management
Maintaining a MAP above 70 mmHg in the acute phase is correlated with better neurological status at 6 months, as shown in a study evaluating the neurological prognosis at 6 months in 92 patients with traumatic spinal cord injury 1. Continuous monitoring of MAP with an arterial catheter is recommended due to the difficulty in achieving target MAP levels.
From the Research
Implications of Spinal Cord Injury at T6 Level
The implications of a spinal cord injury at the T6 level resulting in paraplegia are numerous and can have a significant impact on the individual's quality of life. Some of the potential implications include:
- Neurogenic bladder dysfunction, which can lead to incontinence, renal impairment, urinary tract infections, and poor quality of life 2, 3, 4, 5
- Increased risk of developing urinary tract infections due to loss of normal bladder function and use of catheterization methods 3, 4
- Pressure ulcerations, particularly in individuals with associated spasticity, which can be challenging to manage and may require specialized treatment 6
- Urological complications, such as bladder over-distention, vesicoureteral reflux, and high-pressure voiding, which can increase the risk of infection and other complications 4, 5
- Need for ongoing management and treatment to prevent complications and improve quality of life, including conservative and invasive treatment measures 2, 5
Management and Treatment
Management and treatment of individuals with spinal cord injury at the T6 level resulting in paraplegia may involve:
- Anticholinergic medications and clean intermittent catheterization to manage neurogenic bladder dysfunction 2
- Endoscopic procedures, such as sphincterotomy and botulinum toxin injection, to relieve bladder outlet resistance 2
- Surgical procedures, such as transobturator tape insertion and artificial sphincter implantation, to manage incontinence and other complications 2
- Spasticity control measures, such as medication and physical therapy, to prevent pressure ulcerations and other complications 6
- Ongoing monitoring and evaluation to prevent and manage urological complications and improve quality of life 5