AA

Traumatic SCI

Much of the following epidemiology data on traumatic spinal cord injury in Canada has been extracted from the 2006 Canadian Institute of Health Information Report on Traumatic SCI (CIHI 2006a) using 2003-2004 data from the Canadian National Trauma Registry (NTR).  Over 950 traumatic spinal cord injuries occurred in 2003-2004 (CIHI 2006a).  Reports of the annual incidence vary in part due to differing methods of identifying and tracking injuries, and due to regional differences.  The annual incidence has been estimated at 52.5 per million population (1997-2006) in Alberta (Dryden et al. 2003), 40 per million population (1981-1984) in Manitoba (Hu et al. 1996), and 49 per million population in Ontario in the year 2000 (Pickett et al. 2006). Pickett et al. (2006) also found annual increases in the incidence of SCI from 1997 to 2000. In 1997, the annual incidence was reported at 21 per million population, and increased to 26, 44, and 49 million in 1998, 1999, and 2000 respectively. See SCIRE’s review on the epidemiology of traumatic SCI for a global perspective on the incidence and prevalence of SCI. 

In Canada, males comprise over three-quarters of these traumatic injuries with the majority occurring in those under 35 years of age.  Motor vehicle accidents are commonly reported as the leading cause of SCI injury (with reports ranging from 35.1 to 56.4%), while falls are the second leading cause (with reports ranging from 19.1 to 36%) (NTR 1999; Dryden et al. 2003; Pickett et al. 2006).  The number of SCIs resulting from falls are increasing due to the growing older adult segment of the population. This has contributed to the increase in age of a person with traumatic SCI (from average age 46 in 1994 to average 49 in 1998).  In fact, we are now seeing a bimodal distribution of SCI in the population with one mode centralizing at approximately 30 years of age and another mode centralizing at 60 years of age.  Not surprisingly, falls are the primary cause of SCI admissions in seniors, while motor vehicle crashes are the leading cause in young adults (NRT 1999).  Fractures of the vertebral column, in addition to injuries of the spinal cord represent 71% of all SCI hospital admissions (NTR 1999).  Of the SCI admissions, 44% result in paraplegia and 56% tetraplegia (NTR 1999). 

Traumatic SCI can be complex as motor vehicle accidents or other violent incidents often result in more than injury to the spinal cord.  In particular, patients with the dual diagnosis of traumatic brain injury and spinal cord injury present a challenge to the rehabilitation professional as they are often agitated and have poor concentration.  The percentage of SCI injuries which are accompanied by a traumatic brain injury are substantial, for example, Lida et al. (1999) reported that 35% of SCI had a traumatic brain injury, and in a more recent US study, Macciocchi et al. (2008) found 60% of their SCI sample to have co-occurring traumatic brain injury.

There appears to be a trend towards more severe injuries in Canada. In the 1970s, the Canadian Paraplegic Association (CPA) reported that about 25% of injuries resulted in tetraplegia and 75% paraplegia.  Of the new injuries reported to CPA during 1999, 47% resulted in tetraplegia and 53% resulted in paraplegia.  This increase in tetraplegic injuries concurs with the findings of the US National Spinal Cord Injury Statistical Center (NSCISC)  that, since 2000, tetraplegia has accounted for 52.4% of the injuries, and paraplegia 41.5% (NSCISC 2008). A survey of the epidemiology literature (Wyndaele and Wyndaele 2006) suggests increasing proportions of tetraplegia with a global proportion of approximately two-thirds tetraplegia.

There have been some suggestions that there are increasing numbers of incomplete lesions in some regions (Calancie et al. 2005).  However, these finding are not consistent.  The Model Spinal Cord Systems in the US (Jackson et al. 2004) reported an increase in complete injuries in the 1990s which has since dropped back to pre-1990 levels with just less than half of the injuries being complete, and since 2000, the NSCISC reports complete injuries on average have accounted for 41.3% (NSCISC 2008). The Australian Spinal Cord Injury Registry reported increasing rates in elderly males, fall-related injury and incomplete tetraplegia and complete paraplegia over an eleven year period (O’Connor 2006).

Although the precise relationship between gender and SCI is difficult to determine, it is generally acknowledged that men and women exhibit different patterns with respect to SCI etiology, recovery, and lived experience.  For example, according to data from Model Spinal Cord Injury Care System records, men are 4 times more likely to sustain a SCI than women, although this has slightly decreased since 2000 where 77.8% of injuries are sustained by males compared to pre-1980 rates where males accounted for 81.8% of the spinal cord injuries (NSCISC 2008).  When women do incur a SCI, it is more likely to be incomplete and occur later in life.  Men, in contrast, are more likely to incur a complete injury and do so during their young adult years (Nobunaga et al. 1999).   While the three leading causes of injury do not differ between men and women (motor vehicle crashes, falls, and gunshot wounds), medical/surgical complications occur more frequently among women, whereas violence-related SCI occurs more frequently among men.  Differences in SCI etiology reach peak disparity during the ages of 16 to 30, and become less relevant in later adult years (Nobunaga et al. 1999).