Spinal Cord Injury in the 21st Century Part I: A New Demographic

Area of Science:

• Neurosurgery
• Trauma Surgery
• Spinal Cord Injury Research

Background:

• Existing acute spinal cord injury guidelines primarily address young individuals with spinal fracture dislocations from high-impact trauma.
• Recent clinical observations suggest a shift in the demographic and injury patterns of cervical spinal cord injuries (cSCI).

Purpose of the Study:

• To characterize the contemporary patient population with cSCI at a level 1 trauma center.
• To compare current cSCI demographics and injury types against traditional profiles used in guideline development.
• To test the hypothesis that most cSCI patients now fall outside the scope of established guideline principles.

Main Methods:

• A cross-sectional cohort study design was employed.
• Demographics, injury types, and diagnoses of cSCI patients admitted over 12 months were reviewed.
• Data were cross-referenced from multiple archival systems at a level 1 trauma institution.

Main Results:

• Eighty-two percent of 51 identified cSCI patients lacked spinal fracture or dislocation.
• These patients were older (mean age 62), sustained low-impact injuries (93%), and had lower American Spinal Injury Association (ASIA) grades (98%).
• In contrast, patients with fracture/dislocation were younger (mean age 48), had high-impact injuries (77%), and higher ASIA grades (66%).
• Ninety-eight percent of cSCI patients without fracture/dislocation presented with hand/arm sensory and motor deficits, versus 11% with fracture dislocation (P < 0.0001).

Conclusions:

• Patients with cSCI without fracture or dislocation now constitute the majority at this trauma center.
• This demographic aligns with central cord syndrome, suggesting distinct pathophysiology and natural history.
• Applying management principles from older guidelines to this new patient population is not straightforward.