The evolving landscape of spinal cord injury: a tale of 3 decades.

Abstract

Considerable advances in the prevention and treatment of traumatic spinal cord injury (SCI) have been made in the last 3 decades; hence, it can be assumed that the groups at risk, etiology, and characteristics of SCI have evolved in tandem. The objective of this study was to analyze SCI data to discern changes in patient demographics, etiology, and characteristics of injury over the last 3 decades. Data from 5 multicenter, prospective sources were combined to create a dataset representing the period from 1991 to 2020. The data were divided into 3 decades; 1991-1999, 2000-2009, and 2010-2020. The analyzed variables included patient age, sex, etiology, baseline injury severity based on the American Spinal Injury Association Impairment Scale (AIS), surgery, and timing of surgery. One-way ANOVA was performed to examine the association between patient age and decade, whereas chi-square tests were used to assess the association of sex, etiology, surgery, timing of surgery, and baseline severity with decade. Further analyses were done using univariate and multivariate regression to evaluate the relationship between age and sex, etiology, and decade. The overall dataset included 2642 patients. From the 1990s to the 2010s, the mean age increased independent of changes in etiology (p < 0.001), the frequency of injuries related to falls increased from 20.6% to 42.1% (p < 0.0001), and the frequency of SCIs related to motor vehicle collision decreased from 50.4% to 39.1% (p < 0.0001). Significant changes were observed when examining injury severity between the 1990s and 2010s: the percentage of complete SCI (AIS grade A) decreased from 58.3% to 49.8%, the percentage of incomplete SCI (AIS grades B, C, and D) increased from 41.7% to 50.2%, and the percentage of central cord syndrome increased from 33.7% to 54.7%. The percentage of patients undergoing surgical treatment increased from 73.8% to 96.8% (p < 0.0001), and the proportion that underwent early surgery increased from 20.6% to 43.9% (p < 0.0001). The changes in the demographics, etiology, and characteristics of SCI reflect a combination of an aging population, an increased public awareness of neurotrauma, and enhanced clinical management of older patients. These findings have implications for further research and the optimization of primary and secondary injury prevention strategies.