12: Spinal Cord Injury

INTRODUCTION

Spinal cord injury (SCI) results from trauma or damage to the spinal cord, causing disruption of communication between the brain and spinal cord to end organs and limbs, with resultant sensory, motor, and autonomic dysfunction. The causes of SCI can be divided into traumatic and nontraumatic. Traumatic causes are typically high-velocity events producing neurologic deficits that occur with an acute and recognizable onset. Nontraumatic injuries tend to have a subacute to chronic course, with slower onset of neurologic deficits.

GENERAL CONSIDERATIONS

Epidemiology

Current estimates indicate that between 236,000 and 327,000 people in the United States are living with SCI. There is an estimated annual incidence of SCI, not including those who die at the scene of the accident, of 40 cases per million people in the United States, or approximately 12,000 new cases per year. About 13% of new SCI cases are captured by the National Spinal Cord Injury database, which has a network of SCI model systems that first began collecting data in 1973. There have been 28 SCI model system sites since 1973, and 14 are currently active. From 1973 to 1979, the average age of injury was 28.7 years and most injuries occurred between the ages of 16 and 30 years. Since 2005, the average age of injury have increased to 41.0 years, with 80.6% of injuries occurring in males. Before to 1980, 81.8% of SCIs occurred among males. The incidence of SCI has been decreasing in Caucasians and increasing in minority populations, particularly African Americans and Hispanics. This likely is due, at least in part, to general population trends in the United States. Epidemiologic data for traumatic SCI in British Columbia, Canada, yield similar results, with a median age of injury of 35 years and an 80% gender preference for males. In mainland China, epidemiologic data covering the period from 2001 to 2007 indicated that patients with spinal trauma accounted for 4.58% of all patients hospitalized due to trauma. Among these patients, 69.02% were male and 30.98% were female. The most common causes of spinal trauma were motor vehicle accident (33.6% of SCIs), high falls (31.25%), and falls without height (23.23%), and these causes combined accounted for about 88% of the spinal traumas documented.

Etiology

Data compiled since 2010 show that motor vehicle collisions account for 36.5% of reported traumatic SCIs, falls for 28.5%, violence for 14.3%, sport injuries ...