Epidemiological and etiological profile of spinal cord injury in Brazil: a systematic review and meta-analysis

Spinal Cord Injury (SCI) severely impacts quality of life, yet consistent epidemiological data in Brazil are scarce. This study aimed to delineate the etiological profile of SCI in the Brazilian population to support public health strategies.

We conducted a systematic review and meta-analysis of proportions. Searches were performed in Medline, LILACS, and Embase. From the selected articles, 14 were included in the qualitative synthesis and 9 in the meta-analysis. The risk of bias was assessed using the JBI tool.

The meta-analysis with 8 studies revealed that the main etiologies of SCI were motor vehicle accidents (37.3%; 95% CI: 23.9-51.7), followed by falls (22.7%; 95% CI:16.2-29.9), violence including firearm injuries and physical assault (19.4%; 95% CI: 14.5-24.8), and diving into shallow water (10.9%; 95% CI: 5.1-18.3). Regarding the neurological level, the meta-analysis comprising 6 studies showed a pooled proportion of cervical injury of 37.4% (95% CI, 27.0-48.4). A male predominance was observed. We identified high heterogeneity (I² ranging from 76% to 95%) across all analyses, significant methodological weaknesses (e.g., hospital-based convenience samples), and evidence of publication bias for falls and violence.

The etiological profile of SCI in Brazil reveals motor vehicle accidents as the leading cause, followed by falls and violence; and the most commonly affected neurological level is the cervical region. However, high heterogeneity and the risk of bias in primary studies demand a cautious interpretation of these findings. There is an urgent need for methodologically robust population studies to discover reliable data that can assist in effective public policies for the prevention of spinal cord injuries.