OVERVIEW: Table of Contents

• The Spinal Cord
• Traumatic Spinal Cord Injury
• Facts about Spinal Cord Injury
• Demographics
• Costs of Injury
• Morbidity and Mortality
• Causes
• Consequences
  • Work
  • Home
  • Marriage
  • Hospital Length of Stay

The Spinal Cord

The spinal cord is part of the nervous system and is the largest nerve in the body. Specifically, nerves are cordlike structures which are made up of nerve fibers. These nerve fibers are responsible for the communication systems of the body which include sensory, motor and autonomic functions.

The spinal cord is surrounded by protective bone segments called the vertebral column, or the spinal column. It is made up of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae and five sacral vertebrae.

The spinal cord is about 18 inches long and extends from the base of the brain, down the middle of the back, to about the waist. The nerves that lie within the spinal cord are upper motor neurons (UMNs) and their function is to carry the messages back and forth from the brain to the spinal nerves along the spinal tract. The spinal nerves that branch out from the spinal cord to the other parts of the body are called lower motor neurons (LMNs). These spinal nerves exit and enter at each vertebral level and communicate with specific areas of the body. The sensory portions of the LMN carry messages about sensation from the skin and other body parts and organs to the brain. The motor portions of the LMN send messages from the brain to the various body parts to initiate actions such as muscle movement.

Traumatic Spinal Cord Injury

The term "spinal cord injury" refers to any injury of the neural (pertaining to nerves) elements within the spinal canal. SCI can occur from either trauma or disease to the vertebral column or the spinal cord itself. Most spinal cord injuries are the result of trauma to the vertebral column. These injuries can affect the spinal cord's ability to send and receive messages from the brain to the body systems that control sensory, motor, and autonomic function below the level of injury. Depending on the location and severity of the injury, the body can be affected in a myriad of ways. Typically, the nerves above the injury site continue to function as they always have and the nerves below the site do not.

The type of spinal cord injury is classified by the doctor as "complete" when the nerve damage obstructs every signal coming from the brain to body parts below the injury; it is considered "incomplete" when only some of the signals are obstructed. In an incomplete injury, the amount and type of message that can pass between the brain and parts of the body will depend on how many nerves have not been damaged. The level of injury is determined by which vertebrae of the spinal cord has been injured. The closer the injury is to the brain, the greater the loss of function and feeling will be. A person is said to have paraplegia when he or she has lost feeling and is not able to move the lower parts of the body. Someone with tetraplegia (formerly called quadriplegia) has lost movement and feeling in both the upper and lower parts of the body.

Sometimes the spinal cord is only bruised or swollen after the initial injury and as the swelling goes down, the nerves may begin to work again. Unfortunately, there are no tests which will determine how many nerves, if any, will work again. However, the longer there is no improvement, the less improvement will occur.

In addition to movement and feeling, a spinal cord injury affects other bodily functions, such as breathing, bowel and bladder control. There may also be changes in sexual function.

While we continue to learn more about spinal cord injury, much of the available research and data is still incomplete. We have, however, summarized as much information as possible to give you a better understanding of the many aspects of traumatic spinal cord injury. For more information on spinal cord injury statistics, call the National Spinal Cord Injury Statistical Center in Birmingham, Alabama at 205-934-3320.

Some Facts About Spinal Cord Injury

• Spinal Cord Injury (SCI) results in sensory and/or motor impairment with varyingdegrees of permanent disability.
  
• There are approximately 7,600 - 10,000 new cases of SCI in the United States each year.
  
• Since 1988, 45% of all Spinal Cord Injuries have resulted in complete and 55% have resulted in partial loss of sensation.
  
• There are two classifications for SCI. Complete and Incomplete. Complete injury means total nerve loss and incomplete means partial nerve loss.
  
• After a spinal cord injury, all nerves above the level of injury keep working like they always have. Below the level of injury, the spinal cord nerves cannot send messages between the brain and parts of the body as they did before the injury.
  
• Those with SCI who survive the first year have significantly increased mortality rates relative to the general population.
  
• The approximate number of persons in the United States with SCI is between 183,000 and 230,000.
  

Demographics and Statistics

• There are 7600 to 10,000 Spinal Cord Injuries (SCI) each year in the U.S.
  
• Motor vehicle accidents are the leading cause of SCI (44%), followed by acts of violence (24%), falls (22%), sports (8%), and other causes (2%).
  
• 2/3 of the sports-related injuries are from diving.
  
• Falls overtake motor vehicles as the leading cause after age 45.
  
• Acts of violence and sports cause less injuries as age increases.
  
• Acts of violence have overtaken falls as the second most common source of spinal cord injury.
  
• Persons who sustain SCI consist of approximately 56% Caucasian, 29% African-American, 13% Hispanic, 0.4% American-Indian and 2% Asian.
  
• 82% of the total number of people with SCI are male; 18% female.
  
• The highest per capita rate of injury occurs between ages 16-30.
  
• The average age at time of injury is 33.4 years.
  
• The median age at time of injury is 26 years.
  
• The mode (most frequent) age at time of injury is 19 years.
  
• 53% of the total number of people with SCI were single at the time of injury, 31% were married, 9% divorced, 7% other.
  
• 5 years after the injury, 88% of single people with SCI were still single vs. 65% of the non-SCI population.
  
• 5 years after the injury, 81% of married people with SCI were still married vs. 89% of the non-SCI population.
  

Cost of Injury

Average yearly health care and living expenses that are directly attributed to SCI vary greatly according to severity of injury:

Severity of Injury	First Year	Each Subsequent Year
High Tetraplegia (C1-C4)	$417,067	$74,707
Low Tetraplegia (C5-C8)	$269,324	$30,602
Paraplegia	$152,396	$15,507
Incomplete Motor Functional at Any Level	$122,914	$8,614
All Groups	$198,335	$24,154

These figures do not include any indirect costs such as losses in wages, fringe benefits and productivity which could average almost $38,000 but vary substantially based on education, severity of injury and pre-injury employment history.

Morbidity & Mortality

The most common cause of death is due to diseases of the respiratory system, with most of these being due to pneumonia. In fact, pneumonia is the single leading cause of death throughout the entire 15 year period immediately following SCI for all age groups, both males and females, whites and non-whites, and persons with quadriplegia.

The second leading cause of death is non-ischemic heart disease. These are almost always unexplained heart attacks often occurring among young persons who have no previous history of underlying heart disease.

Deaths due to external causes is the third leading cause of death for SCI patients. These include subsequent unintentional injuries, suicides and homicides, but do not include persons dying from multiple injuries sustained during the original accident. The majority of these deaths are the result of suicide.

The fourth leading cause of death is infective and parasitic diseases (usually septicemia associated with decubitus ulcers, urinary tract or respiratory infections) followed by circulatory diseases, ill-defined conditions, hypertensive and ischemic heart disease, diseases of the digestive system, neoplasms and cerebrovascular disease and cancer.

An increasing number of people with SCI are dying of unrelated causes such as cancer or cardiovascular disease, similar to that of the general population. Mortality rates are significantly higher during the first year after injury than during subsequent years.

Causes of SCI

Since 1990, motor vehicle crashes account for 35% of the SCI cases reported. The next largest contributor is acts of violence (primarily gunshot wounds), followed by falls and recreational sporting activities. Interesting trends in the database show proportions of injuries due to motor vehicle crashes and sporting activities have declined while proportion of injuries from acts of violence has increased over the years.

Consequences

Occupational Status

Residence

Marital Status

Hospital Length of Stay

Overall, average days hospitalized for acute care and rehabilitation immediately following injury has declined from 137 days to 73 days. Similar downward trends are noted for those with paraplegia (from 122 to 69 days) and persons with tetraplegia (from 150 to 80 days).

Source: National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham

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