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Frequently Asked Questions


1. How many spinal cord injuries occur in the U.S. each year?

There have not been any national studies of the overall incidence of SCI in the United States recently. However, state based SCI registries provided both an estimate of SCI incidence in the United States as well as the identification of regional differences in SCI incidence. States known to have had registries include Alabama, Alaska, Arkansas, Colorado, Delaware, Florida, Georgia, Iowa, Louisiana, Maryland, Michigan, Mississippi, New Jersey, New York, Minnesota, North Dakota, Oklahoma, Rhode Island, South Carolina, Utah, Virginia, and West Virginia. Unfortunately, many of these programs have lost funding and no longer exist. Nonetheless, these studies suggest the incidence rate of SCI is about 40 cases per million population, excluding those who die at the scene of the accident. Given a current United States population of over 300 million persons, this means that over 12,000 new cases occur each year.

References:

1.       Chen Y, Tang Y, Vogel L, DeVivo MJ. Causes of spinal cord injury. Top Spinal Cord Inj Rehabil 2013;19: 1-8.

2.       Chen Y. Epidemiology of traumatic spinal cord injury. In: Fehlings, Vaccaro, Boakye, Rossignol, Ditunno, Burns, eds. Essentials of Spinal Cord Injury: Basic research to clinical practice. New York, NY: Thieme Medical Publishers Inc, 2012. P 56-64.

3.       Chen Y. Epidemiology. In: Vogel L, Zebracki K, Betz R, Mulcahey MJ, eds. Spinal Cord Injury in the Child and Young Adult. Mac Keith Press , 2014.

 

 

2. How many people are alive today in the U.S. with SCI?

Estimates vary, but the generally accepted range is that there are between 240,000 and 337,000 persons living with SCI in the United States.

References:

1.       DeVivo MJ, Fine PR, Maetz HM, Stover SL. Prevalence of spinal cord injury: a re-estimation employing life table techniques. Arch Neurol 1980;37:707-8.

2.       Harvey C, Rothschild BB, Asmann AJ, Stripling T. New estimates of traumatic SCI prevalence: a survey-based approach. Paraplegia 1990;28:537-44.

3.       Lasfarques JE, Custis D, Morrone F, Carswell J, Nguyen T. A Model for estimating spinal cord injury prevalence in the United States. Paraplegia 1995;33:62-68.

4.       DeVivo MJ, Chen Y. Trends in new injuries, prevalent cases, and aging with spinal cord injury. Arch Phys Med Rehabil 2011;92:332-338.

 

 

3. Has the incidence of SCI changed in recent years?

We don't know, because there haven't been any national studies of incidence lately. Evidence from the state registries while they were in existence suggests that there are no overall trends in SCI incidence in the United States. However, cause-specific incidence rates do appear to have changed, resulting in more injuries due to falls and fewer injuries due to violence and sports since 2000. The tables on the Spinal Cord Injury Model Systems Annual Statistical Reports (https://www.nscisc.uab.edu/reports.aspx) provide information about the trend in causes of injury over time. 

References:

1.       Glick T. Spinal cord injury surveillance: is there a decrease in incidence? [abstract] J Spinal Cord Med 2000; 23(Suppl):61.

2.       DeVivo MJ.  Epidemiology of spinal cord injury:  trends and future implications.  Spinal Cord 2012;50:365-372.

 

 

 

4. What are the leading causes of SCI?

Motor vehicle crashes rank 1st at 38% followed by falls at 30%, acts of violence at 14%, sports at 9% and all others at 9%. These figures are for all injuries reported to the National Spinal Cord Injury Statistical Center (NSCISC) since 2010. The percentage of cases due to acts of violence increased through the early 1990’s but has since declined. The percentage of cases due to falls has increased steadily since 1973. Cases due to sports have been decreasing.  A quick search tool to find the leading causes of SCI is available on the NSCISC website (https://www.nscisc.uab.edu/public-tools.aspx). Searches can be sorted by type of report (full or condensed), multiple timeframes, race/ethnicity, and gender.

References:

4.       Chen Y, Tang Y, Vogel L, DeVivo MJ. Causes of spinal cord injury. Top Spinal Cord Inj Rehabil 2013;19: 1-8.

 

 

5. How frequently do persons with SCI return to work?

About one third of persons with SCI eventually return to work. Significant predictors of return to work include, but are not limited to, pre-injury work history, education level, age, gender, race, neurologic level and completeness of injury, ability to ambulate independently, and motivation.

 

References:

1.             Krause JS, Kewman D, DeVivo MJ, Maynard F, Coker J, Roach MJ, Ducharme S.  Employment after spinal cord injury: an analysis of cases from the model spinal cord injury systems. Arch Phys Med Rehabil 1999;80:1492-1500.

2.             Pflaum C, McCollister G, Strauss DJ, Shavelle RM, DeVivo MJ. Worklife after traumatic spinal cord injury. J Spinal Cord Med 2006; 29:377-386.

3.             Arango JC, Ketchum J, Francis K, Lewis A, Premuda P, Wehman P, Kreutzer J.  A longitudinal study of effect of race/ethnicity on employment outcomes at 1, 5, and 10 years post spinal cord injury.  PM&R 2010;2:901-910.

4.             Meade MA, Forchheimer MB, Krause JS, Charlifue S.  The influence of secondary conditions on job acquisition and retention in adults with spinal cord injury.  Arch Phys Med Rehabil 2011;92:425-432.

5.             Krause JS, Edles PA, Charlifue S.  Changes in employment status and earnings after spinal cord injury: a pilot comparison from pre- to post-injury.  Top Spinal Cord Injury Rehabil 2011;16(4):74-79.

6.             Botticello A, Chen Y, Tulsky DS.  Geographic variation in participation for physically disabled adults: the contribution of area economic factors to employment after spinal cord injury.  Soc Sci Med 2012;75:1505-1513.

 

 

6. What is the life expectancy for someone with paraplegia or tetraplegia (quadriplegia)?

It depends on their age at injury, how long ago they were injured, and the severity of their injury. Tables from the Facts and Figures at a Glance (https://www.nscisc.uab.edu/reports.aspx) provide rough estimates for life expectancies. A quick search tool to provide an estimate of life expectancy is also available on the NSCISC website (https://www.nscisc.uab.edu/public-tools.aspx).  The tool is designed for people who are at least 2 years post-injury, have access to good quality healthcare, are not on a ventilator, and have not regained all normal feeling and movement.  

 

References:

1.       DeVivo MJ, Krause JS, and Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil 1999;80: 1411-19.

2.       Strauss D, DeVivo MJ, Shavelle R. Long-term Mortality Risk After Spinal Cord Injury. J Insur Med 2000;32:11–16.

3.       Strauss D, Shavelle R, Day S, DeVivo MJ. An Analytic Method for Longitudinal Mortality Studies. J Insur Med 2000;32:217–225.

4.       DeVivo MJ. Estimating Life Expectancy for Use in Determining Lifetime Costs of Care. Top Spinal Cord Inj Rehabil 2002;7(4):49-58.

5.       Strauss DJ, DeVivo MJ, Paculdo DR, Shavelle RM. Trends in life expectancy after spinal cord injury. Arch Phys Med Rehabil 2006;87:1079-1085.

6.       Shavelle RM, DeVivo MJ, Strauss DJ, Paculdo DR, Lammertse DP, Day SM. Long-term survival of persons ventilator dependent after spinal cord injury. J Spinal Cord Med 2006; 29:511-519.

7.       Shavelle RM, DeVivo MJ, Paculdo DR, Vogel LC, Strauss DJ. Long-term survival after childhood spinal cord injury. J Spinal Cord Med 2007; 30(Suppl):S48-S54.

8.       Cao Y, Krause JS, DiPiro N. Risk factors for mortality after spinal cord injury in the USA. Spinal Cord 2013;51:413-418.

 

7. What are the life-time costs for care for someone with SCI?

It depends on how old the person is, and how severe their injury is. The tables on the Facts and Figures at a Glance provide a rough estimate of life-time costs for different ages and injury severity levels (https://www.nscisc.uab.edu/reports.aspx).

 

References:

1.       DeVivo MJ. Causes and costs of spinal cord injury in the United States. Spinal Cord 1997;35: 809- 813.

2.       DeVivo MJ, Chen Y. Mennemeyer ST, Deutsch A. Costs of care following spinal cord injury. Top Spinal Cord Inj Rehabil 2011;16(4):1-9.

3.       Cao Y, Chen Y, DeVivo MJ. Lifetime direct cost after spinal cord injury. Top Spinal Cord Inj Rehabil 2011;16(4):10-16.

 

8. How many patients are injured each year at a particular neurologic level?

The most frequent injury level is C5, followed by C4, C6, T12, and L1. Overall about half are cervical injuries (tetraplegia), and half are either thoracic, lumbar, or sacral injuries. The tables on the Spinal Cord Injury Model Systems Annual Statistical Reports (https://www.nscisc.uab.edu/reports.aspx) provide further detail on neurologic level and completeness of injury. 

 

References:

1.       Chen Y, Tang Y, Vogel L, DeVivo MJ. Causes of spinal cord injury. Top Spinal Cord Inj Rehabil 2013;19: 1-8.

 

9. What is the frequency of occurrence of a particular secondary complication following SCI?

The most frequent secondary medical complications reported to the National Spinal Cord Injury Statistical Center include urinary tract infections, pressure ulcers, pain, depression, spasticity, pneumonia, autonomic dysreflexia, deep vein thrombosis with occasional subsequent pulmonary emboli, renal and bladder stones, renal failure, and heterotopic ossification. The tables on the Spinal Cord Injury Model Systems Annual Statistical Reports (https://www.nscisc.uab.edu/reports.aspx) provide further detail regarding the physical and mental health status over time. 

 

References:

1.       Chen D, Apple DF Jr, Hudson LM, Bode R. Medical complications during acute rehabilitation following spinal cord injury - current experience of model systems. Arch Phys Med Rehabil 1999;80: 1397-1401.

2.       McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ. Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis. Arch Phys Med Rehabil 1999;80: 1402-1410.

3.       Cardenas DD, Bryce TN, Shem K, Richards JS, Elhefni H. Gender and minority differences in the pain experience of people with spinal cord injury. Arch Phys Med Rehabil 2004; 85:1774-1781.

4.       Cardenas DD, Hoffman LM, Kirshblum S, McKinley W.  Etiology and incidence of rehospitalization after traumatic spinal cord injury: a multicenter analysis.  Arch Phys Med Rehabil 2004;85:1757-1763.

5.       Chen Y, DeVivo MJ, Jackson AB. Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects. Arch Phys Med Rehabil 2005; 86:1208-1213.

6.       DeVivo MJ. Trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973-2006. Spinal Cord 2007; 45:713-721.Fann JR, Bombardier CH, Richards JS, Tate DG, Wilson CS, Temkin N.  Depression after spinal cord injury: comorbidities, mental health service use, and adequacy of treatment.  Arch Phys Med Rehabil 2011;92:352-360. 

7.       Chen Y, Cao Y, Allen V, Richards JS.  Weight matters: physical and psychosocial well being of persons with spinal cord injury in relation to body mass index.  Arch Phys Med Rehabil 2011;92:391-398.

8.       Cameron AP, Wallner LP, Forchheimer MB, Clemens JQ, Dunn RL, Rodriguez G, Chen D, Horton J, Tate DG.  Medical and psychosocial complications associated with method of bladder management after traumatic spinal cord injury.  Arch Phys Med Rehabil 2011;92:449-456.

9.       Hoffman JM, Bombardier CH, Graves DE, Kalpakjian CZ, Krause JS.  A longitudinal study of depression from 1 to 5 years after spinal cord injury.  Arch Phys Med Rehabil 2011;92:411-418.

10.   DeVivo MJ.  Epidemiology of spinal cord injury:  trends and future implications.  Spinal Cord 2012;50:365-372.

 

 

10. What are the usual demographics of people who get SCI?

The average age at injury has increased from 29 years during 1970s to 42 years since 2010. There is an about  4 to 1 male to female ratio. Approximately 24% of spinal cord injuries occur among blacks, which is higher than the proportion of blacks in the general population (12%). Please see the updated figures published in the Facts and Figures at a Glance and also the Spinal Cord Injury Model Systems Annual Statistical Reports (https://www.nscisc.uab.edu/reports.aspx). 

 

References:

1.       DeVivo MJ, Chen Y. Trends in new injuries, prevalent cases, and aging with spinal cord injury. Arch Phys Med Rehabil 2011;92:332-338.

2.       Chen Y, Tang Y, Vogel L, DeVivo MJ. Causes of spinal cord injury. Top Spinal Cord Inj Rehabil 2013;19: 1-8.