Spinal Cord Injury Rates Stabilize

Acute traumatic spinal cord injury risk dropped among youth but rose among older adults

(RxWiki News) A spinal cord injury can change a person’s life in an instant, creating new challenges for everyday life. But the good news is that, for most age groups, the chance of these injuries hasn’t changed much in the last two decades.

A new study found that the rate of acute traumatic spinal cord injuries has remained stable in recent years.

"Between 1993 and 2012, the incidence rate of acute traumatic spinal cord injury remained relatively stable but, reflecting an increasing population, the total number of cases increased," wrote lead study author Nitin B. Jain, MD, of the Vanderbilt University School of Medicine in Nashville, TN, and colleagues. "The largest increase in the incidence of spinal cord injury was observed among older patients, largely associated with an increase in falls."

An acute traumatic spinal cord injury (ATSCI) is damage to any part of the spinal cord or nerves at the end of the spinal canal. ATSCI often causes permanent changes in strength, sensation, and other body functions below the site of the injury and can result in partial or complete paralysis.

In some cases, prompt medical care can lower the risk for disability and lasting impairment. In others, paralysis may be complete and permanent.

Dr. Jain and team looked at trends on the number of injuries, health care use and death rates for ATSCI. These researchers used data from the US Nationwide Inpatient Sample (NIS) database for the years 1993 to 2012.

In 1993, Dr. Jain and team found that there were 53 cases of ATSCI per 1 million people. In 2012, there were 54 cases per 1 million people.

In older adults, however — both male and female, age 65 or older — the rate of ATSCI tied to falls increased from 28 percent (in 1997 to 2000) to 66 percent (in 2010 to 2012).

The rate of death from these falls, however — in adults age 85 or older — dropped from 24 percent (in 1993 to 1996) to 20 percent (in 2010 to 2012).

"Underlying arthritis especially in the cervical spine ... leads to narrowing of the spinal canal (where the spinal cord resides), and in many cases there is overt compression of the cord that patients may not be symptomatic from," said John J. Knightly, MD, vice chairman of Atlantic Neuroscience Institute and medical director of Atlantic Health System’s neuro-spine team at Overlook Medical Center in Summit, NJ, and Morristown Medical Center in Morristown, NJ, in an interview with dailyRx News. "At the time of the accident, there is less protection of the cord making it more susceptible to injury. The elderly spine with this arthritis is also 'stiffer' and less likely to absorb and diffuse the trauma leading to increased traumatic forces on the spinal cord itself. This arthritis and poor bone quality can lead to a weakened bone structure, which can fracture more readily."

According to Dr. Jain and team, these rates likely represent a US senior population that is more active compared with that of the 1990s. This increase in activity may be linked to an increased risk of falls, according to these researchers.

"These problems are likely to increase with our aging population," Dr. Jain and colleagues wrote. "Efforts to understand and prevent falls in elderly persons is a public health priority."

Dr. Jain and team also found that spinal cord injuries in males ages 16 to 44 dropped from 1993 to 2012.

“Public education, improved motor vehicle safety features, stricter safety belt laws, and drunk driving laws and their enforcement may have contributed to this overall decline in spinal cord injury rates in these age groups,” Dr. Jain and colleagues wrote.

Dr. Knightly added that "When [walking] difficulties are present, environmental precautions and modifications are key to helping prevent falls from occurring. Both the patient as well as family members must accept and recognize this."

This study was published in the June issue of the the journal JAMA.

Study author Dr. Eric Garshick received royalty fees for spinal cord injury articles from UpToDate, a medical reference website.

Dr. Jain received funding from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the Foundation for Physical Medicine & Rehabilitation.

Study authors Dr. Leslie Morse and Dr. Garshick received funding from the US Department of Veterans Affairs Office of Rehabilitation Research and Development, the National Institutes of Health and the National Institute on Disability and Rehabilitation Research.

Review Date: 
June 8, 2015