SCI Etiology

OT Dude Academy’s Free NBCOT® Exam Prep Course Spinal Cord Injury (SCI) SCI Etiology

Prevalence

In the United States, the number of patients in a nationwide inpatient sample with traumatic SCI averaged 69% of males with the mean age being over 40 years old. A high rate of increase in SCI incidence from 1993 to 2012 was observed in elderly persons from 695 cases to 1465 cases in the timespan.1  A recent study based on the Nationwide Emergency Department Sample estimated the spinal cord injury incidence in 2007-2009 to be 56 per 1 million adults in the United States.2 

Causes

The majority of SCI cases included falls, motor vehicle accidents (MVA), and firearm injuries from 1997 to 2012. Falls were associated with those aged 65 years or older. Firearm discharge causes were related to those aged 16-24-year-old group. MVA attributed to 22% of cases from 1997-2000.1  Other causes included sports-related accidents and violence. The main cause of SCI in developed countries used to be MVAs, but in recent research, it is due to falls. The most common cause of SCI in non-developed countries was still due to falls.3 4 5 6 7 8 9 10 

Non-traumatic SCI (NTSCI) is caused by non-traumatic reasons. Etiologies include vertebral spondylosis (spinal stenosis), tumorous compression, vascular ischemia, and congenital disease.11 12 13 

Level and Severity

The most common location of SCI injury in developed and non-developed countries was at the cervical level.4 14 15 16  The most common level of SCI is at C5, with 35% at the thoracic level and 11% in the lumbar region. 17  Paraplegia can be caused by lower thoracic lesions and quadriplegia is often associated with cervical level lesions.18  A lower percentage of complete injury was found compared to incomplete injury. Tetraplegia was more common than paraplegia in both developed and non-developed countries except Turkey and Canada.8 9 19 20  Motor-complete (ASIA A or B) injuries were more common for patients with traumatic SCI while motor-incomplete injuries (ASIA C or D) were more common for patients with non-traumatic SCI.6 21 22 

Prognosis

Clinically, neurological outcomes are determined 72 after injury using the ASIA scoring system.23 24  Whether the injury was complete or incomplete may be an important predictor of functional recovery. Some SCI patients may experience spontaneous recovery of motor and sensory function. Most recovery occurs during the first 3 months and often reaches a plateau by 9 months after injury. Additional recovery recurs up to 18 months post-injury. Therefore, long-term outcomes are related to the level of injury, the severity of the injury, and the progression of secondary injuries.23 

Patients who have incomplete paraplegia generally have a good prognosis for regaining locomotor ability within a year. Patients with incomplete paraplegia will gain better recovery than patients with complete paraplegia and complete tetraplegia. Recovery from incomplete tetraplegia can occur at multiple levels below the level of injury. The presence of muscle flicker (multiple local involuntary muscle contractions) is associated with lower extremity recovery of function.

Patients with complete paraplegia often experience limited recovery of lower extremity function if their injury is above T9. An injury below T9 is associated with 38% chance of regaining some lower extremity function.24 

Patients with complete tetraplegia often regain function at one level below the level of injury. Therefore, diagnosis of an incomplete injury is important as failure to detect sensory preservation at sacral regions may result in an inaccurate assessment or prognosis. 24 25 26 

Mortality

The overall life expectancy of SCI survivors depends on their level of injury and preserved functions. SCI wheelchair users have a 75% of normal life expectancy compared to non-wheelchair users, who have 90% of normal life expectancy.27  Acute inpatient mortality was 6% in 1993-1996 and 8% in 2010-2012. Mortality increased with older age, but showed a decreasing trend over time among those aged 85 years or older.1 

  1. Jain, N. B., Ayers, G. D., Peterson, E. N., Harris, M. B., Morse, L., O’Connor, K. C., & Garshick, E. (2015). Traumatic spinal cord injury in the United States, 1993-2012. Jama, 313(22), 2236-2243.[↩][↩][↩]
  2. Selvarajah S, Hammond ER, Haider AH, et al. The burden of acute traumatic spinal cord injury among adults in the United States: an update. J Neurotrauma. 2014;31(3):228-238.[↩]
  3. Nijendijk JH, Post MW, van Asbeck FW. Epidemiology of traumatic spinal cord injuries in The Netherlands in 2010. Spinal Cord. 2014;52(4):258–263.[↩]
  4. Montoto-Marqués A, Ferreiro-Velasco ME, Salvador-de la Barrera S, Balboa-Barreiro V, Rodriguez-Sotillo A, Meijide-Failde R. Epidemiology of traumatic spinal cord injury in Galicia, Spain: trends over a 20-year period. Spinal Cord. 2017;55(6):588–594.[↩][↩]
  5. Bárbara-Bataller E, Méndez-Suárez JL, Alemán-Sánchez C, RamírezLorenzo T, Sosa-Henríquez M. [Epidemiology of traumatic spinal cord injury in Gran Canaria]. Neurocirugia (Astur). 2017;28(1):15–21. Spanish.[↩]
  6. Taşoğlu Ö, Koyuncu E, Daylak R, et al. Demographic and clinical characteristics of persons with spinal cord injury in Turkey: one-year experience of a primary referral rehabilitation center. J Spinal Cord Med. Epub 2016 Oct 20.[↩][↩]
  7. Chamberlain JD, Deriaz O, Hund-Georgiadis M, et al. Epidemiology and contemporary risk profile of traumatic spinal cord injury in Switzerland. Inj Epidemiol. 2015;2(1):28[↩]
  8. Shrestha P, Shrestha S, Shrestha RK. Retrospective study of spinal cord injury patients admitted to spinal injury rehabilitation center, Sanga, Banepa, Nepal. Nepal Med Coll J. 2014;16(2–4):169–172.[↩][↩]
  9. Sabre L, Pedai G, Rekand T, Asser T, Linnamägi U, Kõrv J. High incidence of traumatic spinal cord injury in Estonia. Spinal Cord. 2012;50(10):755–759.[↩][↩]
  10. Ning GZ, Yu TQ, Feng SQ, et al. Epidemiology of traumatic spinal cord injury in Tianjin, China. Spinal Cord. 2011;49(3):386–390.[↩]
  11. Adams RD, Salam-Adams M. Chronic nontraumatic diseases of the spinal cord. Neurol Clin. 1991;9(3):605–623.[↩]
  12. Dawson DM, Potts F. Acute nontraumatic myelopathies. Neurol Clin. 1991;9(3):585–603.[↩]
  13. Schmidt RD, Markovchick V. Nontraumatic spinal cord compression. J Emerg Med. 1992;10(2):189–199.[↩]
  14. Löfvenmark I, Norrbrink C, Nilsson-Wikmar L, Hultling C, Chakandinakira S, Hasselberg M. Traumatic spinal cord injury in Botswana: characteristics, aetiology and mortality. Spinal Cord. 2015;53(2):150–154[↩]
  15. Pickett GE, Campos-Benitez M, Keller JL, Duggal N. Epidemiology of traumatic spinal cord injury in Canada. Spine (Phila Pa 1976). 2006;31(7):799–805.[↩]
  16. O’Connor RJ, Murray PC. Review of spinal cord injuries in Ireland. Spinal Cord. 2006;44(7):445–448[↩]
  17. Hachem LD, Ahuja CS, Fehlings MG. Assessment and management of acute spinal cord injury: from point of injury to rehabilitation. J Spinal Cord Med. (2017) 40:665–75. doi: 10.1080/10790268.2017.1329076[↩]
  18. Wilson JR, Cadotte DW, Fehlings MG. Clinical predictors of neurological outcome, functional status, and survival after traumatic spinal cord injury: a systematic review. J Neurosurg Spine. (2012) 17(1 Suppl.):11–26. doi: 10.3171/2012.4.AOSPINE1245[↩]
  19. Alshahri SS, Cripps RA, Lee BB, Al-Jadid MS. Traumatic spinal cord injury in Saudi Arabia: an epidemiological estimate from Riyadh. Spinal Cord. 2012;50(12):882–884.[↩]
  20. Bellucci CH, Castro Filho JE, Gomes CM, et al. Contemporary trends in the epidemiology of traumatic spinal cord injury: changes in age and etiology. Neuroepidemiology. 2015;44(2):85–90.[↩]
  21. Dryden DM, Saunders LD, Rowe BH, et al. Depression following traumatic spinal cord injury. Neuroepidemiology. 2005;25(2):55–61.[↩]
  22. Shin JC, Kim DH, Yu SJ, Yang HE, Yoon SY. Epidemiologic change of patients with spinal cord injury. Ann Rehabil Med. 2013;37(1):50–56[↩]
  23. Michael Fehlings AR, Boakye M, Rossignol S, Ditunno JF Jr, Anthony S. Burns Essentials of Spinal Cord Injury Basic Research to Clinical Practice. Denver, CO: Thieme Medical Publishers Inc. (2013).[↩][↩]
  24. Waters RL, Adkins RH, Yakura JS, Sie I. Motor and sensory recovery following incomplete tetraplegia. Arch Phys Med Rehabil. (1994) 75:306–11. doi: 10.1016/0003-9993(94)90034-5[↩][↩][↩]
  25. Waters RL, Yakura JS, Adkins RH, Sie I. Recovery following complete paraplegia. Arch Phys Med Rehabil. (1992) 73:784–9.[↩]
  26. Ditunno JF Jr,, Sipski ML, Posuniak EA, Chen YT, Staas WE Jr,, Herbison GJ. Wrist extensor recovery in traumatic quadriplegia. Arch Phys Med Rehabil. (1987) 68(5 Pt 1):287–90.[↩]
  27. Shavelle RM, Paculdo DR, Tran LM, Strauss DJ, Brooks JC, DeVivo MJ. Mobility, continence, and life expectancy in persons with Asia Impairment Scale Grade D spinal cord injuries. Am J Phys Med Rehabil. (2015) 94:180–91. doi: 10.1097/PHM.0000000000000140[↩]
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