Epidemiology of spinal cord injuries: a reflection of changes in South African society

The records of all patients (492 males and 124 females) admitted into a spinal rehabilitation programme over a period of 6 years were reviewed. Most of the patients were in the age group 20-29 years and trauma accounted for 89% of all spinal cord lesions. Gunshot injuries were the commonest (36%), followed by injuries related to motor vehicle accidents (MVA) (25%), stab wounds (20%) and falls from heights (2.4%). Aetiological patterns changed over the 6 year period covered: gunshot injuries increased markedly and stab wounds decreased in number. The records of a medico-legal laboratory in the same geographic region revealed the same trend. Neurological recovery rates were better in patients with stab wounds and nontraumatic lesions than in those with MVA-related injuries and gunshot wounds. When compared to similar studies from other countries, our results show a disproportionately high incidence of violent injuries, particularly gunshot wounds, in South African plegic patients. We concluded that the recent sociopolitical changes and especially the general escalation of violence in the country, is reflected in the observed changes in the epidemiology of spinal cord injuries.