See All Evidence Sections
Epidemiology of Traumatic SCI

Other Causes

There were 48 papers reporting SCI due to “other causes” (Table 14). In some studies, this may have included the specific causes discussed above, miscellaneous causes not mentioned earlier or unique causes of SCI. The majority of studies were from Europe (N=16 studies) with some representation from North America (N=13 studies), Asia (N=12 studies), Africa (N=3 studies) and Oceania (N=4 studies). Eighteen of these studies reported SCI due to being struck by an object.

Proportions of SCI due to “other causes” ranged from a low of 0.2% in Tianjin, China (Ning et al. 2011) to a high of 16.3% in Beijing, China (Li et al. 2011). The reported frequency of the majority of papers were between 5.3% and 11.0% (N = 16 studies). Proportions of SCI due to “struck by object” ranged from 2.0% in New Zealand (Dixon et al. 1993) to 18.6% in Beijing, China (Li et al. 2011). The majority of papers reported frequencies between 2% and 5% (N=9).

Author
Year
N of study
population
Geographic
region
Inclusion/
exclusion criteria
Study
population
Injury features Cause: %(n of
cases)
Middleton et al.
2012
N=324
New South
Wales,
Australia
January 2004 to
June 2008, Data
from Ambulance
Service of New
South Wales
Males = 85%
Mean age = 42
years
Not Specified Other: 8.3%
Wu et al.
2012
N=143
Tianjin, China Patients admitted
to Tianjin Medical
University General
hospital with
diagnosis of tSCI
Mean age 54.6
years
Male:Female =
5:1
ASIA A = 5.6%
ASIA B = 16.8%
ASIA C = 18.9%
ASIA D = 58.7%
Other: 1.4%
AlcanyisAlberola et al.
2011
N=250
Valencia,
Spain
Iatrogenic SCI (SCI
preced by any
diagnostic,
surgical,
pharmacological or
physical therapy
procedure carried
out by healthcare
professionals or
prescribed by a
physician
Exclusion: patients
who underwent
surgery due to
tumors
Mean age=56.2
years
Cervical=31%
Thoracic=25%
Lumbar=41%
Sacrum=3%
Iatrogenic SCI =
10.4% of total
DeVivo et al.
2011
N=45,442
USA 1935-2008
Persons who were
treated at either a
SCI Model System
or a Shriners
Hospital SCI unit
N = 45,442
Males= 79.2%
Mean age at
injury= 32.5 years
19.8% C1-4
32.6% C 5-8
45.4% Paraplegic
2.2% Normal
Other:
8.0%
(n=3,635)
Li et al.
2011
# of patients:
N=1079
data collected:
N=264
Beijing,
China
Patients with acute
TSCI admitted to
civilian or military
hospitals during
Jan 1- Dec 31
2002
200 male (76%)
Mean age: 41.7
years
Range: 6-80
years
Cervical (4.9%)
Thoracic (28%)
Thoracolumbar,
lumbar and
lumbosacral (66%)
Other:
(16.3%)
n=43
McCammon
and Ethans
2011
N=553
Manitoba,
Canada
1981-1985, 1998-
2002, 2003-2007
Inclusion criteria:
survival to hospital
admission with
TSCI, or outpatient
referral to an SCI
rehabilitation
specialist.
Exclusion criteria:
congenital causes of paralysis such
as spina bifida or
cerebral palsy as
well as acquired
paralysis from
multiple sclerosis
or Guillan-Barre
syndrome.
75.8% male
Mean Age:
1981-1985: 29.0
years
1998-2002: 35.3
years
2003-2007: 39.8
years
1981-1985:
Cervical: 46.2%
Thoracic:33.0%
Lumbar: 20.9%
Sacral:0.0%
1998-2002:
Cervical:45.0%
Thoracic:33.3%
Lumbar: 21.6%
Sacral:0.0%2003-2007:
Cervical:51.3%
Thoracic:34.9%
Lumbar:12.5%
Sacral:1.3%
Other:
81-85: 3.6%
98-02: 0.0%
03-07: 1.2%
Ning et al.
2011
N=869
Tianjin,
China
All patients with
TSCI aged 15 or
older admitted to
tertiary hospitals in
Tianjin from Jan 1,
2004- Dec 31,
2008
738 male (84.9%)
Mean age (sd)
46.0 (14.2)
Cervical (71.5%)
Thoracic (13.3%)
Lumbar (15.1%)
Sacral (0.1%)
Other:
(0.2%)
n=2
Wu et al.
2011
N=41,586
Taiwan All SCI patients
older than 20 years
of age and
admitted to
medical services
from 1998-2008
that were identified
using the National
Health Insurance
Research
Database of
Taiwan.
62% male
(n=25857)
61.2% had
traumatic SCI
(n=25,439)
Cervical: 51.8%
N=21,557
Thoracic: 12.3%
N=5,098
Lumbar: 22.9%
N=9,533
Other SCI: 13.0%
N=5,398
Other:
10.4%
n=2646
calculated using N
traumatic SCI=
25,439)
Couris et al.
2010
N=936
Ontario,
Canada
The study included
all patients aged
18 years or older
living in Ontario
during the fiscal
years 2003–2004
(through 2006–
2007) who
experienced TSCI.
74.1% (n=694)
male
mean age:
51.3±20.1 years
65.5% (n=610)
cervical
21.3% (n=198)
thoracic
10.0% (n=93) lumbar
3.2% (n=30) other
Other:
13.5%
(n=126)
Hagen et al.
2010
N=336
Norway (2
counties:
Hordaland and
Sogn og
Fjordane)
Patients who
suffered a TSCI
from 1952-2001
and lived in
Hordaland or Sogn
og Fjordane
Male to female
ratio was 4:7:1
% of women
varied from 6.9-
24.4%
Complete (41.4%)
Incomplete (58.6%)
Cervical (52.4%)
Thoracic (29.5%)
Lumbar/sacral
(18.2%)
Other: 10.3%
(n=34)
NSCISC 2010
N=26,852
USA 1973-2009
26 federally funded
Model SCI Care
Systems and
National SCI
Database
Male= 80.8%
(1973-2009)
Mean age at
injury = 40.2
years (2005-
2009)
2005-2009
Tetraplegia = 55.2%
Paraplegia = 44.4 %
Complete Tetraplegia
= 16.9%Incomplete
tetraplegia = 38.3%
Complete Paraplegia
= 22.9%
Incomplete
Paraplegia = 21.5%
Other:
8.5%
(n=2,282)
Pirouzmand
2010
N=12,192
Toronto,
Canada
1986-2006
SCI and SI in
Sunnybrook
Trauma Registry
Database
[SI
Male=66%
Median age=36
years] SCI
Male= 76%
Median age=33
years
CSCI
Median age= 30
years
[Spinal Injury= 23.2%
-Cervical= 29%
– Thoracic= 21%
– Lumbosacral= 50%] SCI= 5.4%
– Cervical=29%
– Thoracic=21%
– Lumbo-sacral =
50%
– Multiple Levels=
20%
CSCI=3%
Other:
4.1%
(n=500)
Qureshi et al.
2010
N=521
Rawalpindi,
Pakistan
All patients who
suffered a spinal
injury from nondisaster causes
and were admitted
to the Spine Unit of
a tertiary care
hospital in Pakistan
from 2001-2008.
402 male (77%)
Mean age (sd)
39.1 (16.17)
Level of injury:
Thoraco-lumbar
spine (n=369, 71%),
lower cervical spine
(n=93, 18%), upper
cervical spine (n=42,
8%) and sacrum
(n=9, 2%).
Injuries at multiple
levels in 8 (2%)
Complete SCI-(43%)
Incomplete SCI-
(33%)
Hit by falling object:
4%
(n=21)
Chabok et al.
2009
N=245
Guilan,
Iran
Patients admitted
to Poursina
Hospital, with TSCI
71.8% male Neurological status:
15 complete
29 incomplete
201 no neurological
damage
cervical- n=17
thoracic- n=6
thoracolumbar- n=48
Lumbar= 12
Other:
2.4%
(n=6)
Obalum et al.
2009
N=468
Lagos,
Nigeria
1992-2006
Registrars at the
emergency room
and wards from the
Lagos University
Teaching Hospital (receives the
majority of SCI
patients in Lagos)
70.1% male,
66.2% were ages
40 years and
below. Peak age
incidence = 21-30
years.
ASIA A n=230
ASIA B n=45
ASIA C n=36
ASIA D n=41
ASIA E n= 34
Death n=82Lumbar n=278
Cervical n=142
Thoracic n=48
Other:
0.4%
(n=2)
Ahoniemi et al.
2008
N=1647
Finland 1976-2005
Register survey;
Medical records
from registers of
Käpylä
Rehabilitation
Centre
Males = 83%
Mean age of
injury (M/F):
1976-1985:
34.7/35.8
1986-1995:
36.7/38.3
1996-2005:
42.4/40.4
50.6% tetraplegia
49.4% paraplegia
Other:
10.0% (n=165)
National Spinal
Cord Injury
Statistical
Center
2008
N=25,415
USA 26 federally funded
Model SCI Care
Systems and
National SCI
Database
Males=77.8%
Average age =
39.5 years
Incomplete
tetraplegia: 34.1%
Complete paraplegia:
23.0%
Complete
tetraplegia:18.3%
Incomplete
paraplegia: 18.5%
Other:
8.1% (n=2059)
Fassett et al.
2007
N=412
Philadelphia,
Pennsyl-vania,
USA
1978-2005
Treated in
Delaware Valley
Regional Spinal
Cord Injury Center
at Thomas
Jefferson
University Hospital
≥70 years old High quadriplegic
(C4 and above)=42%
Paraplegic=22%
ASIA A ~ 45%
ASIA B ~ 13%
ASIA C ~ 15%
ASIA D ~ 24%
Other:
11%
(n=45)
Shrestha et al.
2007
N=149
Eastern region,
Nepal
2001-2004
Admission to
hospital in Dharan
with cervical spinal
injury.
Males=80%
Mean age=40 (6-
88) years
Mortality=6 (4%)
Frankel levels:
A=54 (36%)
B=20 (13%)
C=22 (15%)
D=19 (13%)
E=34 (23%)
Struck by object:
9.4% (n=14)
Animal related:
3.4% (n=5)
Olasode et al.
2006
N=71
Ile-Ife, Nigeria,
Africa
All traumatic SCI
within an 18 month
period were
included. Only
patients with
significant
craniocerebral
injuries were
excluded.
Males=66.7%
Age range=12-80
years
Tetraplegic n=39
Paraplegic n=13
Recovered with no
residual disability
n=14
Died n=5
Other:
7.0%
(n=5)
Calancie et al.
2005
N=229
Dade County,
Florida,
USA
Acute traumatic
spine and/or spinal
cord injury
admitted to
Jackson Memorial
Hospital
Male = 74.6%
Average age at
injury= 40.0±17.5
years
15 children
ASIA A = 32.8% (75)
ASIA B = 4.8% (11)
ASIA C = 24.0% (55)
ASIA D = 31.5% (72)
ASIA E = 7.0% (7.4)
Cervical = 62%
T1-T10 = 15% (35)T11-L4 = 19% (44)
Other:
0.9% (n=2)
Blunt trauma:
6.1% (n=14)
(not due to
MVC,falls, diving,gunshot wounds, or
work-related)
Dahlberg et al.
2005
N=152
Helsinki,
Finland
January 1, 1999
cross-section date
Adult citizens (18
years or more) of
Helsinki who had
permanent sensory
or motor deficits
because of
traumatic SCI
(ASIA A–D). ASIAE cases were
excluded.
Males=76%
Average age of
injury=47.9 years
Data only for 121
subjects:
46% (n=56)
tetraplegia
54% (n=65)
paraplegia
57% (n=69)
incomplete
43% (n=52) complete
Other:
9%
(n=13)
Gur et al.
2005
N=539
South-eastern
Anatolia,
Turkey
1990-1999
4 hospitals that
were major referral
centers for trauma
Males = 77.2%
Average age of
injury=30.62 (1-
70) years
Civil servants:
22.6% (n=120)
Housewives:
20.2% (n=109)
Soldiers: 15.0%
(n=79)
Incomplete
paraplegia 29.3%
(n=158)
Complete paraplegia
45.1% (n=243)
Incomplete
tetraplegia 13.7%
(n=74)
Complete tetraplegia
13.9% (n=75)
Cervical: 25.4%
(n=137)
Thoracic: 36.7%
(n=198)
Lumbar: 34.0%
(n=183)
Other:
4.8%
(n=26)
Lakhey et al.
2005
N=233
Dharan, Nepal May 1997- April
2001
Orthopaedic ward
of BP Koirala
Institute of Health
Sciences
Males = 72.5% <20years old =26 (11.1%), 20-30yrs =59 (25.3%), 31-40yrs =49 (21.0%), 41-50yrs =37 (15.9%), >50yrs =62 (26.6%); Cervical = 88 (37.8%)
Dorsal = 70 (30.0%)
Lumbar = 72 (30.9%)
None bony = 3
(1.3%)
Complete = 46.8%
Carrying load on
head:
4.7% (n=11)
Other:
10.7% (n=25)
National Spinal
Cord Injury
Statistical
Center
2005
N=23,683
USA 25 federally funded
Model SCI Care
Systems and
National SCI
Database
Males= 79.6%
Average age of
injury=37.6 years
Incomplete
tetraplegia (34.5%)
Complete tetraplegia
(18.4%)
Incomplete
paraplegia (17.5%)
Complete paraplegia
(23.1%)
Other:
6.8% (n=161)
Catz et al.
2002N=250
Israel 1959-1992 Traumatic SCI,
admitted to the
Loewenstein
Rehabilitation
Center, the major
referral center for
rehabilitation
medicine in Israel.
Males=75.6%

Mean age = 34.5
years (range 6-83
years).

High cervical 7.6%
low cervical 28.8%thoracic 32.4%
lumbar 31.2%
Violence and Sports
10.4% (n=26)
National Spinal
Cord Injury
Statistical
Center
2000
N=19648
USA 24 federally funded
Model SCI Care
Systems and
National SCI
Database
Males = 81.7%
55% within 16-30
years old, mean
age at injury is
31.8
years
Complete Tetraplegia
= 18.5%
Incomplete
tetraplegia = 29.5%
Complete Paraplegia
= 27.9%
Incomplete
Paraplegia = 21.3%
Other:
7.9% (n=1552)
Caldana &
Lucca
1998
N=127
Veneto,
Italy
1994-1995
New cases of
traumatic spinal
cord injury and
non-traumatic
spinal cord disease
treated in regional
hospitals (small
hospitals excluded)
Males = 83.5%;
Average age
(male) of 39.8
years
Average age
(female) of 36
years
Cervical=62 (21
complete)
Thoracic = 29 (25
complete)
Thoracolumbar (T12-
L1)=18(11 complete)
Caudal=14
(3complete)
Unidentified=1
Other:
0.9%
(n=5)
Martins et al.
1998
N= 398
Portugal 1989-1992
2 hospitals that
treat all SCI in the
central region of
Portugal. Including
deaths due to SCI
and pediatric
cases. Cases
without
neurological lesion,
rehospitalization
and vertebral
lesions were
excluded.
Males=77%
Average age =
50.53±21.85
years
Complete n=220
Incomplete n=176
Deaths = 223
Other:
5.3% (n=21)
Chen et al.
1997
SCI=1,586
Taiwan 1992-1996
113 hospitals (11
medical centers,
50 regional general
hospitals, 52 local
general hospitals)
Males = 75.0%
Average age of
injury=46.1 years
Cervical 49.9%
Thoracic 13.3%
Lumbar 34.6%
Died after treatment
6.6% (n=105)
Struck by object:
2.1% (n=33)
Other:
4.7% (n=73)
Exner &
Meinecke
1997
N= 22,212
Germany 1976-1996
All traumatic and
non-traumatic SCI
72% male. 62% paraplegic
38% tetraplegic
Other:
12%
(n=2,665)
Otom et al.
1997
N=151
Jordan 1988-1993
Royal Jordanian
Rehabilitation
Centre (RJRC)
King Hussein
Medical Centre
(KHMC)
Males = 85.4%
Average age of
injury=33 years
Cervical=31.8%
(n=48)
Thoraco-lumbar=
68.2% (n=103)
Frankel A= 53.6%
(n=81)
Frankel B = 10%
(n=15)
Frankel C =22.5%
(n=34)
Frankel D= 13.9%
(n=21)
Struck by object:
3.3%
(n=5)
Karamehmetaglu 1995
N=152
Istanbul,
Turkey
1992
New patients with
traumatic SCI,
including
pediatrics.
Males = 75.7%
Mean age = 33
years. 72% of
patients were
under 40.
Tetraplegic n=50
Paraplegic n=102
Struck by object:
7%
(n=78)
Levi et al. 1995
N=353
Stockholm,
Sweden
1991-1994
Survey of the
regional Stockholm
SCI population
Males=81%
Average age of
injury=31 (3-77)
years
Cervical
41.6% (n=147)
Thoracic
36.0% (n=127)
Lumbar 14.7%
(n=52)
Sacral 1.4% (n=5)
Complete
39.4% (n=139)
Incomplete
59.5% (n=210)
Other:
7.9%
(n=28)
Shingu et al.
1995
N=9752
Japan 1990-1992
Survey of
nationwide
institutions
assumed to accept
SCI patients.
Exclusion criteria:
Patients only
receiving
outpatient services
in this period
Males=80.4%
Mean
age=48.6±19.1
(0.92-96) years.
Frankel levels:
A=2518 (25.8%)
B=1208 (12.4%)
C=1984 (20.3%)
D=1761 (18.1%)
E=2242 (23.0%)
Struck by object:
5.5% (n=536)
Hart et al.
1994
N=616
South Africa 1988-1993
All records of SCI
from the
Natalspruit Spinal
Rehabilitation Unit
Males= 80%
Males between
15-40 made up
the majority of
patient
Complete n=404
Incomplete n=212
Cervical spine n=155
Upper thoracic n=135
Lower thoracic n=249
Lumbar spine n=74
Other:
5.6% (n=34)
Price et al.
1994
N=376
Oklahoma,
USA
1988-1990
SCI cases in
Oklahoma
statewide
multilevel surveillance
system
Exclusion Criteria:
Non Oklahoma
residents; patients
who died at scene;
injuries to nerve
roots or spinal
plexus
Males=80%
15-19 years
=66 (18%)
20-29 years
=110 (29%)
30-59 years=145 (39%)
≥60 years
=43 (11%)
Mortality=30 (8%)
Complete
tetraplegia=55 (15%),
Incomplete
tetraplegia
=157 (42%)Complete
paraplegia=59 (16%),
Incomplete
paraplegia
=105 (28%)
Struck by object:
4.3% (n=16)
Other:
4.0% (n=15)
Shingu et al.
1994
N=3465
Japan 1990
Survey of
nationwide
institutions
assumed to accept
SCI patients
(residents);
Exclusion criteria:
Traumatic cervical
syndrome cases
and extradural
nerve root
Mean age=47.8
years
Cervical=126 (60.3%)
Below cervical=83
(39.7%)
Struck by object:
6.0% (n=208)
Acton et al.
1993
N=644
Arkansas,
USA
1980-1989
Arkansas residents
in Arkansas State
Spinal Cord
Commission
registry.
Exclusion Criteria:
Lesions caused by
degenerative
disease; people
who died at scene.
Males =80%
Mean age
males=32.4 years
Mean age
females=35.4
years
Tetraplegia=13
Paraplegia=19
Struck by object:
5.3% (n=34)
Dixon et al.
1993
N=164
New Zealand 1988
SCI cases in
Health Services
Statistics files.
Males=73.2%
Males aged 15-29
years=46%
C1-C4=49 (30%)
C5-C7=30 (18%)
T1-T6=19 (12%)
T7-T12-19 (12%)
Exertion/
Strain:
3.0% (n=5)
Struck by object:
2.0% (n=3)
Tator et al.
1993
N=201
Toronto,
Canada
1974-1981
First 220
admissions to
Acute Spinal Cord
Injury Unit in
Toronto.
Exclusion Criteria:
Admissions >30
days after injury;
spinal injuries
without cord
involvement; nerve
root involvement
only; penetrating injuries; injuries
below L2; Patients
who died on scene
or upon arrival
Males=79.6%
Mean age=34.5
years
Median age=27.0
years
Cervical=63.2%,
Thoracic=16.9%,
Thoracolumbar=19.9%
Complete=46.2%,
Incomplete=53.8%
Other:
10.5% (n=21)
Dincer et al.
1992
N=1,694
Turkey 1974-1985
SCI patients
admitted to Ankara
Rehabilitation
Centre
Males = 75.7%
Average age of
injury=26.8 (1-70)
years
Agricultural
workers=
19.8% (n=336)
Housewives=
19.9% (n=338)
Private industry
workers =
19.5% (n=330)
Complete paraplegia
85.1% (n=1442)
Incomplete
paraplegia 6.9%
(n=116)
Complete tetraplegia
4.8% (n=82)
Incomplete
tetraplegia 3.2%
(n=54)
Other:
11.10% (n=188)
GarciaReneses et al,
1991
N=1010
Spain 1984-1985
Every traumatic
and non traumatic
SCI patient in
specialized
Spanish hospitals
72.4% male.
Mean age = 41.8
± 1.2 years.
Sensory-motor
incomplete SCI =
49%
Complete SCI= 38%
Struck by Object:
3.2%
(n=32)
Other:
14.1%
(n=142)
BieringSorensen et al.
1990
N=268
Kingdom of
Denmark
(Denmark,
Greenland,
Faroe Islands)
january 1975-
December 1984
Admission to
national
specialized
rehabilitation
hospitals
Male=76.9%
40% within 15-24
years old
Cervical = 136
Thoracic = 76
Lumbar = 56
Complete tetraplegia
= 22%
Incomplete
tetraplegia = 29%
Complete paraplegia
= 26%
Incomplete
paraplegia = 23%
Other:
1.0% (n=3)
Struck by object:
3.0% (n=8)
Crush accident:
2.0% (n=6)
Pedersen et al.
1989
N=27
Greenland 1965-1986
Admissions to
rehabilitation
hospital in
Hornback with
traumatic SCI;
Patients injured in
Greenland.
Males=74%
Mean age=33.5
(14-50) years.
Struck by Object:
Incomplete
tetraplegia=1
Incomplete
paraplegia=1
Struck by object:
7.4% (n=2)
Gun accidents:
14.8%(n=4)
Ring et al.
1986
N=202
New South
Wales,
Australia
1977-1978
Admissions to New
South Wales
hospitals with
spinal injury; death
certificates that
involved spinal
injury. 99% of
cases had neurological
involvement.
Males= 81%
15-24 years=
84 (42%)
25-44 years=
58 (29%)
45-64 years=30
(15%)
≥65 years=
15 (7%)Mortality=
69 (39%)
Glasgow Outcome
Scale:
Severe
disability=98(49%)
Moderate
disability=19(9%)
Good
recovery=13(6%)
Not recorded=3(1%
Other:
9.4% (n=19)
Chen et al.
1985
N=560
Taipei,
Taiwan
1978-1981
All record from
general hospitals in
Taipei. Included all
spinal cord lesion
with or without
vertebral injury.
Males= 86%
Mean age = 35.9
(range 20-49)
years.
ncomplete
Paraplegia n=118
Complete paraplegia
n=180
Incomplete
Tetraplegia n=117
Complete Tetraplegia
n=145
Death n=31
Struck by object:
14.6%
(n=82)
Other:
5.6%
(n=30)
Gee and Sinha
1982
N=36
Papua New
Guinea
1978-1981
Traumatic injury
Patients that
stayed in Port
Moresby, Lae and
Manding hospitals
Males = 88%
Mean age =
26years
(range 16-41
years)
Cervical = 22%
Upper thoracic =
11%
Thoraco-lumbar =
28%
Lumbar = 39%
Other:
13.9% (n=5)
Related Downloads
Outcome Measures