Traumatic and Nontraumatic Spinal Cord Injuries

Owing to the aging of the population in the United States, it is anticipated that injury mechanisms, treatment, and outcomes of spinal cord injuries (SCI) will change. There is a scarcity of literature on nontraumatic SCI. Our goal in this study was to evaluate the causes, management, complications, and outcomes after SCI.

In a retrospective review, patients with traumatic and nontraumatic SCI admitted to the inpatient rehabilitation unit at a level 1 trauma center from 2003 to 2013 were reviewed.

In all, 757 entries were identified, and 685 unique patients met our inclusion criteria; 17.4% were <35 years of age, 51.7% were 35 to 64 years of age, and 30.9% were at least 65 years old. The young adults had the highest proportion of fractures (60.5%) and subluxations (21.8%), whereas the oldest group had the highest rates of stenosis (35.4%), spondylotic myelopathy (16.5%), and cancer (15.1%). In SCI patients <35 years of age, 66.6% of injuries were caused by traumatic mechanisms of injury compared with 30.2% in the geriatric cohort. In the total of all SCI, 61.6% were nontraumatic. Surgical management was more prevalent with increasing age (58.8%, 73.7%, 82.1% from youngest to oldest group), as were overall rates of complications (58.6%, 59.4%, 66.7%). Mortality rates significantly increased with age (2.5%, 18.9%, 40.6% overall mortality rates in the 3 age groups). The overall mortality rate in nontraumatic SCI patients was 27.7% compared with 14.8% in traumatic SCI patients.

Falls caused significantly more SCIs than expected, but most SCIs were predominantly nontraumatic in cause. The epidemiology of SCI is shifting rapidly.