Case of Paraplegia

A 30 year old male is brought in by paramedics with history of injury at rugby field. The patient describes the injury as forced forward flexion of body by someone dodging from behind and he fell to the ground, which was followed by some players falling on his back. After which he complained of no sensations or possible movements in his both lower limbs.

He lies on bed, and a primary survey indicates preserved A, B, and Cs. In examination of debility, we assess the sensory dermatomal distribution from the abdomen downwards, T10 at umbilicus, T12 at pubis, L1 at Inguinal ligament preserved. No sensation below this level (to dull and pin prick), no motor functions, loss of muscle tone, No DTRs. No sensations at scrotal skin, but tenderness on pressing the testicles. Log roll done to reveal tenderness and step deformity at L1, and loss of rectal tone.

(Picture courtesy: Netter's Atlas)

An X ray of the LS Spine is done and is displayed below:

The case demonstrates dermatomal approach to delineate the site of vertebral injury, and emphasizes on learning the dermatomal distribution of both the upper and lower limbs to be used in traumatic spinal injuries.