Epidemiology of Spinal Cord Injury and Associated Mortality, Past and Present. Is There a Difference?

Background: The demographics of the population with spinal cord injury (SCI) have been dynamic over time, especially as a result of aging. This study investigated the patterns of SCI admissions by age in the United States over the past decade.

Methods: Data were evaluated (2010-2021), from the National Spinal Cord Injury Model Systems records. Patients were compared based on age (<70 and ≥70 years), analysis of mortality, neurologic level of injury, neurologic improvement, mortality by American Spinal Injury Association (ASIA) grade, and neurologic level of injury. Patients older than 70 years were defined as elderly.

Results: The mean age of the 8137 patients reviewed was 42.6 years (range, 15-88 years). The mean admission rate per year was 678 (range, 378-758). For the elderly versus the younger cohort, the incidence of falls decreased by 5% versus 3.3%, vehicle accidents increased by 3% versus 14%, high tetraplegia increased by 14.7% versus 22.5%, and low tetraplegia decreased by 12% versus 5.7%. In the elderly, ASIA grades A, B, and C decreased significantly, whereas ASIA grade D increased by 23.8%. In the younger cohort, ASIA grade A and B injuries increased, whereas grades C and D increased, all <5%. Overall, 32.1% of those with ASIA grade A and 68% with ASIA grade B injuries improved within 1-2 years after injury. In-hospital and 1-year mortality decreased by 14.5% and 35.4%, respectively, in the elderly.

Conclusions: The incidence of SCI increased. High cervical and incomplete injuries increased, whereas complete SCIs declined. In-hospital and 1-year mortality decreased. There was recovery in select cases of complete SCIs within 1 year.