1. Epidemiology of Spinal Cord Injury

ACTIONABLE NUGGET:
Be aware of the most important health risks for patients with spinal cord injuries.

The Problem

The average family practice will typically have only 1 or 2 patients with a spinal cord injury (SCI). SCI is a low-prevalence, but a high-impact condition, with predictable secondary complications. These patients depend on their family physician to recognize important health problems and treat them aggressively.

If you have someone in your practice with a spinal cord injury, it will be important for you to understand the most common health issues that bring them to your office. This series of post cards is designed to help you with that. This first one offers an introduction to the epidemiology of spinal cord injury.

Evidence-based Best Practice

The incidence of spinal cord injury in Canada is estimated between 3-5/100,000 population; prevalence estimates vary between 40-80,000. There is a bimodal distribution of incidence, with peaks in the 3rd and 8th decades. Onset may be traumatic (~40%; auto collisions, falls, surgical) or non-traumatic (~60%; tumours, neurological conditions).

Although survival has increased significantly in recent decades, people with SCI still have life expectancies several years shorter than their non-disabled contemporaries. The most common causes of premature mortality are respiratory and cardiovascular complications. Increasingly people with SCI die of the same causes as the general population: cancer or cardiovascular disease. Suicide risk is significantly higher among patients with SCI. Factors affecting survival include: duration & severity of disability, poverty, fracture/surgery, depression, and substance abuse.

The most common health concerns associated with SCI are: pain (musculoskeletal and/or neurological), pressure injuries, urinary tract infections, bowel problems, autonomic dysreflexia, depression and sexual dysfunction. The remaining Nuggets focus on these, and offer a concise summary of the latest and best evidence needed by family physicians to provide excellent care for these patients.

Key Reference

National Spinal Cord Injury Statistical Center (2016). Facts and Figures at a Glance. Birmingham, AL: University of Alabama at Birmingham.

Actionable Nuggets (4th ed., 2019)

Additional References (since 2016)

Adriaansen, J. J. E., Ruijs, L. E. M., van Koppenhagen, C. F., van Asbeck, Floris W. A, Snoek, G. J., van Kuppevelt, D., . . . Post, M. W. M. (2016). Secondary health conditions and quality of life in persons living with spinal cord injury for at least ten years. Journal of Rehabilitation Medicine, 48(10), 853-860. doi:10.2340/16501977-2166

Bárbara-Bataller, E., Méndez-Suárez, J. L., Alemán-Sánchez, C., Sánchez-Enríquez, J., & Sosa-Henríquez, M. (2018). Change in the profile of traumatic spinal cord injury over 15 years in spain. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1), 27-8. doi:10.1186/s13049-018-0491-4

Divanoglou, A., Augutis, M., Sveinsson, T., Hultling, C., Levi, R., Medicinska fakulteten, . . . Avdelningen för samhällsmedicin. (2018). Self-reported health problems and prioritized goals in community-dwelling individuals with spinal cord injury in sweden. Journal of Rehabilitation Medicine, 50(10), 872-878. doi:10.2340/16501977-2383

Hatch, B. B., Wood-Wentz, C. M., Therneau, T. M., Walker, M. G., Payne, J. M., & Reeves, R. K. (2017). Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury. Spinal Cord, 55(6), 540-544. doi:10.1038/sc.2016.182

Krause, J. S., PhD, Cao, Y., PhD, DeVivo, M. J., DrPH, & DiPiro, N. D., PhD. (2016). Risk and protective factors for cause-specific mortality after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 97(10), 1669-1678. doi:10.1016/j.apmr.2016.07.001

New, P. W. (2016). Secondary conditions in a community sample of people with spinal cord damage. The Journal of Spinal Cord Medicine, 39(6), 665-670. doi:10.1080/10790268.2016.1138600

Marion, T. E., Rivers, C. S., Kurban, D., Cheng, C. L., Fallah, N., Batke, J., . . . Street, J. T. (2017). Previously identified common post-injury adverse events in traumatic spinal cord Injury—Validation of existing literature and relation to selected potentially modifiable comorbidities: A prospective canadian cohort study. Journal of Neurotrauma, 34(20), 2883-2891. doi:10.1089/neu.2016.4933

Rouanet, C., Reges, D., Rocha, E., Gagliardi, V., & Silva, G. S. (2017). Traumatic spinal cord injury: Current concepts and treatment update.Arquivos De Neuro-Psiquiatria, 75(6), 387-393. doi:10.1590/0004-282×20170048

Stillman, M. D., MD, Barber, J., MS, Burns, S., MD, Williams, S., MD, & Hoffman, J. M., PhD. (2017). Complications of spinal cord injury over the first year after discharge from inpatient rehabilitation. Archives of Physical Medicine and Rehabilitation, 98(9), 1800-1805. doi:10.1016/j.apmr.2016.12.011

To see earlier references, click here