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Do Patients With Spinal Canal Stenosis Experience Spontaneous Quadriparesis Without An Injury?

Posted on Wed, 2 Jan 2019

Question: Do you know of any research on how often people with severe spinal canal stenosis have spontaneous quadraparesis without an injury? What are the risks of not doing surgery?

Answered by Dr. V. N. S. Parinam (1 hour later)

Brief Answer:
Unlikely without injury

Detailed Answer:
Hi,

I went through the attached report. It says about mild to moderate lower thoracic spinal stenosis. I do not see any stenosis of cervical or lumbar spinal vertebrae to have paresis.
Although I do not have research on this kind of case, it is unthinkable to have quadriparesis in such people. Second spontaneous weakness or paralysis without injury is uncommon.

Quadriparesis is paralysis of all the four limbs which can never happen in thoracic spinal stenosis.

More over stenosis is restricted to T10-11 vertebrae which do not innervate lower limbs as well.

So paresis is distant. If the present stenosis progresses upwards into the upper thoracic vertebra there would be restrict of movements and paralysis of respiratory muscles which is quite serious.

So do not think about paresis but restriction of respiratory muscle movement is key.

Hope I made it clear.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. V. N. S. Parinam (22 hours later)

Thank you for your quick and thorough response. I intended to the attach a MRI report of cervical spine instead of the thoracic spine which is now uploaded with this follow up. Following this MRI, the patient saw a neurosurgeon and no treatment was recommended. Three months later he experienced this onset of quadriparesis. The patient was sitting at his desk, reached for something on his desktop and his arm didn't work, followed by his other upper extremity then both legs. In a matter of minutes he was seized by muscle spasms. The next day they fused his spine and the patient suffered respiratory failure. It seems to be unusual to have such a spontaneous response without a precipitating injury. To date, patient is breathing on his own and has no speech difficulties but has not regained any functional movement in any extremity. Is this unusual? Was treatment warranted prior to the event?

Answered by Dr. V. N. S. Parinam (2 hours later)

Brief Answer:
Spinal stenosis.

Detailed Answer:

Hi,

I think the fusion was delayed in the case.

It is very common to see respiratory failure following spinal fusion.

It is good that the patient is breathing on his own. That means the thoracic spine stenosis is not quickly progressing. Since the thoracic spine does not move the chances of respiratory muscle paralysis is low.

I am not sure if the quadriparesis would recover. Rehabilitation is the only alternative without functional compromise.

The fusion was warranted before the event.

Regards,
Dr. Suma Parinam, General & Family Physician

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Above answer was peer-reviewed by : Dr. Nagamani Ng