The changing demographics of traumatic spinal cord injury: An 11-year study of 831 patients

Abstract

Context/objective: Traumatic spinal cord injuries (T-SCI) have a devastating impact and place a significant financial burden on the healthcare system. The incidence of T-SCI ranges from 10.4 to 83 cases per million and varies with age, sex, or geographical region. This study describes the epidemiology and demographic characteristics of patients treated for T-SCI in our region over 11 years.

Design: Retrospective cohort study.

Setting: Single Level-I trauma center in Québec, Canada.

Participants: Patients who sustained T-SCI between 1 April 2000 and 31 March 2011.

Interventions: None.

Outcome measures: Data concerning T-SCI patients was retrieved from the Québec Trauma Registry. Information on age, sex, trauma, level of injury, type and severity of neurological deficit (ASIA scale), and treatment was extracted. Annual, age-standardized rates of T-SCI were calculated and trends over time were examined.

Results: Eight hundred and thirty-one patients with T-SCI were identified. The incidence of T-SCI did not change over time but there was a 13-year increase in age between 2002 and 2010. More than 60% of patients aged 55 years or more were injured following a fall and 80% became tetraplegic. These patients were more likely to have central cord syndrome (CCS) and incomplete neurological injury, compared to younger patients. The incidence of CCS increased from 25 to 37% over 11 years.

Conclusions: The T-SCI population is aging and is more frequently sustaining injuries associated with CCS, incomplete neurological deficits and tetraplegia.

Keywords: Central cord syndrome; Epidemiology; Spinal cord injury; Tetraplegia; Trauma.

Figures

Figure 1

Annual incidence of T-SCI referred to our Center in Québec, Canada. Figure showing the variation over time of the incidence (in cases per million population) of T-SCI in Québec, Canada from 2000 to 2010. Two groups are represented: individuals aged

Figure 2

Etiology of T-SCI according to age group. Figure demonstrating the varying etiology of T-SCI according to age (

Figure 3

Level of SCI (cervical, thoracic, or lumbar) as a function of age. Figure illustrating the proportion of cervical (gray), thoracic (horizontal bars), and lumbar (black) levels of SCI according to age. On the left is the younger population (

Figure 4

Percentage of individuals with T-SCI who sustain CCS: a breakdown by etiology of trauma. The percentage of individuals with CCS (in gray) is expressed as part of the whole T-SCI (in white) population and divided according to etiology of trauma. The proportion of individuals with CCS clearly varies according to trauma etiology and simple falls incur the highest risk of CCS.

Figure 5

Severity of neurological deficit in individuals with T-SCI who sustain CCS: a breakdown by ASIA grade. The percentage of individuals with CCS (in gray) is expressed as part of the whole T-SCI (in white) population and divided according to severity of neurological deficit. Four grades of neurological deficit according to the ASIA (American Spine Injury Association) scale are shown: A – complete neurological deficit; B–D – incomplete neurological deficits in decreasing severity.