1. Epidemiology of Spinal Cord Injury

Actionable Nuggets for SCI (2nd ed., 2013)

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

The Problem:

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). Prevalence estimates vary between 40-80,000 including both traumatic and non-traumatic lesions; therefore the average family practice will typically have only 1 or 2 patients with SCI.

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 cause of death is no longer renal failure; currently respiratory and cardiovascular complications, such as pneumonia and septicemia, contribute to premature mortality. An increasing number of 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 and severity of disability, poverty, fracture/surgery, depression, substance abuse.

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

Key reference:

    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.

Additional References:

    Ahoniemi, E., Pohijolainen, T., & Kautianen. H. (2011). Survival after spinal cord injury in Finland. Journal of Rehabilitation Medicine, 43(6):481-5.
    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.
    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.
    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.
    Dryden, D.M., et al. (2003). The epidemiology of traumatic spinal cord injury in Alberta, Canada. Canadian Journal of Neurological Sciences, 30(2): 113-21.
    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.
    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.
    Hitzig, S.L., et al. (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
    Ho, C.H., et al. (2007). Spinal cord injury medicine. 1. Epidemiology and classification. Archives of Physical Medicine & Rehabilitation, 88(3 Suppl 1): S49-54.
    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.
    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.
    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.
    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.
    McCammon, J.R., Ethans, K. (2011). Spinal cord injury in Manitoba: a provincial epidemiological study. Journal of Spinal Cord Medicine, 34(1): 6-10.
    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.
    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.
    Noreau, L., et al. (2000). Secondary impairments after spinal cord injury: A population-based study. American Journal of Physical Medicine & Rehabilitation, 79(6): 526-35.
    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.
    Pickett, G.E., et al. (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
    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.