Spinal cord injury is a debilitating medical condition resulting in significantly impaired physical health. As of 2024, the World Health Organisation estimates that there are more than 15 million people currently living with spinal cord injury globally, with an estimated annual incidence rate of around 54 cases per million population in the United States alone, or approximately 18,000 new cases per year.
What is Quadriplegia?
Quadriplegia (otherwise known as tetraplegia), is the result of a Cervical spinal cord injury, either complete or incomplete, roughly accounting for 46%–55% of all spinal cord injuries. C5-6 is the most common location of the injury among all quadriplegic patients. Patients who sustained cervical spine trauma present with various degrees of loss of upper limb functions, respiratory function and autonomic dysfunction depending upon the location, cause and nature of the spinal cord injury. A great majority of the patients with cervical spinal cord injury also present with neuropathic pain and spasticity.
The socio-economic cost for cervical spinal cord injury survivals is significantly higher than those suffering from paraplegic spinal cord injury, mostly due to the fact that these patients depend, fully or partially, on carers for their activities of daily life. Moreover, many patients with cervical and higher thoracic injuries are prone to developing autonomic dysfunction requiring more frequent hospital visits. Many patients with higher cervical injuries also require mechanical ventilation, at least during the early phase of their recovery, and some patients depend on mechanical ventilation for their whole life
What is the Difference Between Quadriplegia and Tetraplegia?
Quadriplegia and tetraplegia both refer to impairment affecting all four limbs following injury to the cervical spinal cord. The terms describe the same condition. “Quadriplegia” is used more commonly in patient-facing settings, while “tetraplegia” appears more often in medical literature and international classifications.
Causes of Cervical Spinal Cord Injuries
The most common cause of cervical spinal cord injury is traumatic insult to the spinal cord including motor vehicle accidents, falls, sports accidents and violence. The World Health Organisation estimates that about 90% of all spinal cord injuries have traumatic causes. The lower cervical spine (the lower part of the neck) is the most common area affected by these injuries. Possible non-traumatic causes include ischemia or hemorrhage, spinal cord tumors and traumatic brain injuries resulting in brainstem and upper cervical spinal cord injuries.
Quadriplegia by Level: What C3, C4, C5, and C6 Injuries Mean
The loss of upper body and autonomic functions is directly correlated with the location of the injury, cause of the injury and severity of the injury. Injuries involving cranio-cervical junction (C1-2) and upper cervical spine (C3-4) are more likely to present with diaphragm paralysis caused by injury to the phrenic nerve motor neurons at C3 and C4 levels. These patients also exhibit complete loss of functions in upper limbs and require mechanical ventilation with or without tracheostomy, some throughout the life. Patients with lower cervical injuries (C5-7) usually retain or regain the diaphragm functions however still exhibit severe loss of upper body function, many to the extent where they require 24 nursing services or carer for the activities of their daily life. Many patients with cervical injuries also suffer from autonomic dysreflexia and are prone to severe fluctuations in blood pressure levels, and body temperature dysregulation. A great majority of the patients also suffer from moderate or severe neuropathic pain, particularly in their upper extremities. Some patients with lower cervical injuries such as C7 level partially retain hand and finger function and are partially or fully independent in the ADLs.
Complete vs Incomplete Quadriplegic Spinal Cord Injuries
Quadriplegic spinal cord injuries can be classified as complete or incomplete, depending on how much nerve signaling is preserved below the level of injury. A complete spinal cord injury means there is a total loss of motor and sensory function below the level of injury. In quadriplegia, this typically results in no voluntary movement or sensation in the arms, trunk, or legs below the affected cervical level. Complete injuries are classified as AIS A on the ASIA (American Spinal Injury Association) Impairment Scale.
An incomplete spinal cord injury means that some motor or sensory function remains below the level of injury. This may include partial movement, preserved sensation, or both. In incomplete quadriplegia, the degree of function can vary widely—from minimal finger movement or sensation to more meaningful upper-limb control. Incomplete injuries are classified as AIS B–D.
Epidural Spinal Cord Stimulation for Quadriplegic Spinal Cord Injuries
Epidural spinal cord stimulation is the most innovative treatment option available to many spinal cord injury survivors. This option includes the implantation of a neurostimulator into the epidural space over a specific part of the spinal cord. Many patients with cervical spinal cord injuries such as those suffering from complete or near complete tetraplegia require the implantation of two neurostimulators. The first stimulator is implanted over the lower cervical spinal cord, roughly at C7-T1 level to target the network of nerves responsible for upper body motor function and the 2nd device is implanted over the lumbar spinal cord (roughlyT12) to target the motor function in lower limbs. This option provides the most comprehensive approach which allows for the simultaneous recovery of both upper and lower limb motor function.
Epidural Stimulation for Quadriplegia at Verita Neuro
Verita Neuro is the only treatment provider offering the option to implant dual Epidural Stimulators, a treatment designed specifically for quadriplegic patients. During the surgery, laminectomies are performed to reach the epidural spaces at lower cervical and lumbar levels to implant a 16-electrode array into the epidural space. These electrodes cover all of the spinal segments responsible for upper and lower limb functions. After the surgery, a comprehensive mapping process begins, which involves using specific electrical intensities, specifically targeting various muscles in the upper and lower body. During an advanced stage both stimulators are mapped together to stimulate the muscle functions in upper and lower limbs simultaneously.
Success Stories of Epidural Stimulation treatment for Quadraplegic patients
Verita Neuro has treated more than 96 patients with quadriplegia at our hospitals in Bangkok, Thailand, and Guadalajara, Mexico, using this combined approach. The great majority of these quadriplegia patients have reported moderate or significant improvements in both upper and lower limb functions.
Quadriplegic patient: Karen, C4-C5 complete
Quadriplegic patient: Bryce, C5 complete
Quadriplegic patient: Nikita, C4 complete
Quadriplegic patient: Marcin, C3, C5, and C6 incomplete
Quadriplegic patient: Karlo, C4 incomplete
Quadriplegic patient: Mike, C4-C5 complete
References
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