1. Epidemiology of Spinal Cord Injury

Actionable Nuggets for SCI (3rd ed., 2016)

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

The Problem:

Prevalence estimates for spinal cord injury vary between 40,000-80,000 in Canada; therefore the average family practice will typically have only 1 or 2 patients with SCI.

If you have someone in your practice with a spinal cord injury (SCI), it will be important for you to understand the most common health issues that are bring people with SCI into contact with family medicine. Spinal cord injury is a low-prevalence, but a high-impact condition, and patients with spinal cord injuries depend on their family physician to recognize important health problems and treat them aggressively. 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. Several studies report a bimodal distribution of age at onset, with peaks in the 3rd and 8th decades. Onset may be traumatic (~40%; auto collisions, falls) or non-traumatic (~60%; tumours, neurological conditions).

Although survival has increased significantly in recent decades, people with SCI still have life expectancies several years less than their non-disabled contemporaries, depending on the severity and completeness of disability. The most common causes of premature mortality are currently respiratory and cardiovascular complications. Factors affecting survival include: duration and severity of disability, poverty, fracture/surgery, depression, substance abuse. 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.

In addition to the usual health concerns associated with aging, patients with SCI experience excess morbidity from secondary complications (such as pain, pressure injuries, urinary tract infections, bowel problems, autonomic dysreflexia, depression and other chronic conditions). The remaining “Nuggets” focus on the most common secondary complications and other chronic conditions seen in primary care, and the knowledge needed by family physicians to provide excellent care for these patients.

Key Reference:

Noonan, V. K., Fingas, M., Farry, A., Baxter, D., Singh, A., Fehlings, M. G., & Dvorak, M. F. (2012). Incidence and prevalence of spinal cord injury in Canada: a national perspective. Neuroepidemiology, 38(4), 219-226. http://doi.org/10.1159/000336014

Additional References (chronological listing):

Saunders, L. L., Clarke, A., Tate, D. G., Forchheimer, M., & Krause, J. S. (2015). Lifetime prevalence of chronic health conditions among persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 96(4), 673–679. http://doi.org/10.1016/j.apmr.2014.11.019
New, P. W., Cripps, R. A., & Bonne Lee, B. (2014). Global maps of non-traumatic spinal cord injury epidemiology: towards a living data repository. Spinal Cord, 52(2), 97–109. http://doi.org/10.1038/sc.2012.165
Osterthun, R., Post, M. W. M., van Asbeck, F. W. A., van Leeuwen, C. M. C., & van Koppenhagen, C. F. (2014). Causes of death following spinal cord injury during inpatient rehabilitation and the first five years after discharge. A Dutch cohort study. Spinal Cord, 52(6), 483–488. http://doi.org/10.1038/sc.2014.28
Cao, H., & Dong, E. (2013). An update on spinal cord injury research: Epidemiology, Diagnosis, and Treatment for the Emergency Physician. Trauma Reports, 38(1), 1. http://doi.org/10.1007/s12264-012-1277-8
Fehlings, M. (2013). Essentials of spinal cord injury: Basic research to clinical practice (1st ed.). New York: Thieme.
Jensen, M. P., Truitt, R., Schomer, K. G., Yorkston, K. M., Baylor, C., & Molton, I. R. (2013). Frequency and age effects of secondary health conditions in individuals with spinal cord injury: a scoping review. Spinal Cord, 51(12), 882–92. http://doi.org/10.1038/sc.2013.112
Lenehan, B., Street, J., Kwon, B. K., Noonan, V., Zhang, H., Fisher, C. G., & Dvorak, M. F. (2012). The epidemiology of traumatic spinal cord injury in British Columbia, Canada. Spine, 37(4), 321-329. http://doi.org/10.1097/BRS.0b013e31822e5ff8
Ahoniemi, E., Pohijolainen, T., & Kautianen. H. (2011). Survival after spinal cord injury in Finland. Journal of Rehabilitation Medicine, 43(6), 481-5.
DeVivo, M.J., & Chen, Y. (2011). Trends in new injuries, prevalent cases, and aging with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 92(3), 332-8.
Krause, J.S., Saunders, L.L., & DeVivo, M.J. (2011). Income and risk of mortality after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 92(3), 339-45.
McCammon, J.R., & Ethans, K. (2011). Spinal cord injury in Manitoba: a provincial epidemiological study. Journal of Spinal Cord Medicine, 34(1), 6-10.
Couris, C.M., Guilcher, S.J., Munce, S.E., Fung, K., Craven, B.C., Verrier, M., & Jaglal, S.B. (2010). Characteristics of adults with incident traumatic spinal cord injury in Ontario, Canada. Spinal Cord, 48(1), 39-44.
Cosar, S.N., Yemisci, O.U., Oxtop, P., Cetin, N., Sarifakioglu, B., Yalbuzdag, S.A., Ustaomer, K., et al. (2010). Demographic characteristics after traumatic and non-traumatic spinal cord injury: A retrospective comparison study. Spinal Cord, 48(12), 862-6.
Farry, A., & Baxter, D. (2010). The incidence and prevalence of Spinal Cord injury in Canada. Rick Hansen Institute.
Giannini, M.J., Bergmark, B., Kreshover, S., Elias, E., Plummer, C., & O`Keefe, E. (2010). Understanding suicide and disability through three major disabling conditions: Intellectual disability, spinal cord injury, and multiple sclerosis. Disability Health Journal, 3(2), 74-8.
Guilcher, S.J., et al. (2010). Health care utilization in non-traumatic and traumatic spinal cord injury: a population-based study. Spinal Cord, 48(1), 45-50. http://dx.doi.org/10.1038/sc.2009.78
Hagen, E.M., Lie, S.A., Rekland, T., Gilhus, N.E., & Gronning, M. (2010). Mortality after traumatic spinal cord injury: 50 years of follow-up. Journal of Neurological Neurosurgery Psychiatry, 81(4), 368-73.
Kirchberger, I., Biering-Sorensen, F., Charlifue, S., Baumberger, M., Campbell, R., Kovindha, A., et al. (2010). Identification of the most common problems in functioning of individuals with spinal cord injury using the International Classification of Functioning, Disability and Health. Spinal Cord, 48(3), 221-229.
Pickelsimer, E., Shiroma, E. J., & Wilson, D. A. (2010). Statewide investigation of medically attended adverse health conditions of persons with spinal cord injury. Journal of Spinal Cord Medicine, 33(3), 221-231.
Pirouzmand, F. (2010). Epidemiological trends of spine and spinal cord injuries in the largest Canadian adult trauma center from 1986 to 2006. Journal of Neurosurgery Spine, 12(2), 131-40.
Van Den Berg, M. E. L., Castellote, J. M., De Pedro-Cuesta, J., & Ignacio, M. F. (2010). Survival after spinal cord injury: A systematic review. Journal of Neurotrauma, 27(28), 1517-1528.
Krause, J. S., Zhai, Y., Saunders, L. L., & Carter, R. E. (2009). Risk of mortality after spinal cord injury: an 8-year prospective study. Archives of Physical Medicine & Rehabilitation, 90(10), 1708-1715.
Manchikanti, L., Singh, V., Datta, S., Cohen, S. P., Hirsch, J. A., & American Society of Interventional Pain. (2009). Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician, 12(4), 35-70.
Munce, S. E., Guilcher, S. J., Couris, C. M., Fung, K., Craven, B. C., Verrier, M., et al. (2009). Physician utilization among adults with traumatic spinal cord injury in Ontario: a population-based study. Spinal Cord, 47(6), 470-476.
Hitzig, S. L., Tonack, M., Campbell, K. A., McGillivray, C. F., Boschen, K. A., Richards, K., & Craven, B. C. (2008). Secondary health complications in an aging Canadian spinal cord injury sample. American Journal of Physical Medicine & Rehabilitation, 87(7), 545-55.
http://dx.doi.org/10.1097/PHM.0b013e31817c16d6
New, P.W., & Sundararajan, V. (2008). Incidence of non-traumatic spinal cord injury in Victoria, Australia: A population-based study and literature review. Spinal Cord, 46, 406-11.
Ho, C. H., Wuermser, L. A., Priebe, M. M., Chiodo, A. E., Scelza, W. M., & Kirshblum, S. C. (2007). Spinal cord injury medicine. 1. Epidemiology and classification. Archives of Physical Medicine & Rehabilitation, 88(3 Suppl 1), S49-54. http://dx.doi.org/10.1016/j.apmr.2006.12.001
Pickett, G. E., Campos-Benitez, M., Keller, J. L., & Duggal, N. (2006). Epidemiology of traumatic spinal cord injury in Canada. Spine, 31(7), 799-805. http://dx.doi.org/10.1097/01.brs.0000207258.80129.03
Dryden, D. M., Saunders, L. D., Rowe, B. H., May, L. A., Yiannakoulias, N., Svenson, L. W., … & Voaklander, D. C. (2003). The epidemiology of traumatic spinal cord injury in Alberta, Canada. Canadian Journal of Neurological Sciences, 30(2), 113-21.
http://cjns.metapress.com/app/home/
Noreau, L., Proulx, P., Gagnon, L., Drolet, M., & Laramée, M. T. (2000). Secondary impairments after spinal cord injury: A population-based study. American Journal of Physical Medicine & Rehabilitation, 79(6), 526-35. http://dx.doi.org/10.1097/00002060-200011000-00009