Epidemiology of traumatic spinal cord injury: trends and future implications

Study design: Review supplemented by inception cohort. Objectives: To review trends in the incidence, prevalence, demographic characteristics, etiology, injury severity and selected treatment outcomes of traumatic spinal cord injury (SCI). Setting: International review and US model systems cohort. Methods: An extensive literature review was conducted to identify all relevant studies of descriptive epidemiology of traumatic SCI. This review was supplemented by analyses of trends in US SCI epidemiology that are reflected in the National Spinal Cord Injury Statistical Center and Shriners Hospital Spinal Cord Injury databases. Results: Incidence and prevalence of traumatic SCI in the United States are higher than in the rest of the world. Average age at injury is increasing in accordance with an aging general population at risk. The proportion of cervical injuries is increasing, whereas the proportion of neurologically complete injuries is decreasing. Injuries due to falls are increasing. Recent gains in general population life expectancy are not reflected in the SCI population. Treatment outcomes are changing as a result of increasing age and changes in US health care delivery. Conclusion: Within the prevalent population, the percentage of elderly persons will not increase meaningfully until the high mortality rates observed among older persons significantly improve. Those who reach older ages will typically have incomplete and/or lower level injuries, and will have relatively high degrees of independence and overall good health. Spinal Cord (2012) 50, 365-372; doi:10.1038/sc.2011.178; published online 24 January 2012