History and epidemiology of spinal cord injury

History and epidemiology of spinal cord injury

Spinal cord injury is a mortal condition and has been recognised as such since antiquity. In about 2500 BC, in the Edwin Smith papyrus, an unknown Egyptian physician accurately described the clinical features of traumatic tetraplegia (quadriplegia) and revealed an awareness of the awful prognosis with the chilling advice: “an ailment not to be treated”. That view prevailed until the early years of this century. In the First World War 90% of patients who suffered a spinal cord injury died within one year of wounding and only about 1% survived more than 20 years. Fortunately, the vision of a few pioneers — Guttmann in the United Kingdom together with Munro and Bors in the United States — has greatly improved the outlook for those with spinal cord injury, although the mortality associated with tetraplegia was still 35% in the 1960s. The better understanding and management of spinal cord injury have led to a reduction in mortality and a higher incidence of incomplete spinal cord damage in those who survive. Ideal management now demands immediate evacuation from the scene of the accident to a centre where intensive care of the patient can be undertaken in liaison with a specialist in spinal cord injuries.

At present the annual incidence of spinal cord injury within the United Kingdom is about 10 to 15 per million of the population. In recent years there has been an increase in the proportion of injuries to the cervical spinal cord, and this is now the most common indication for admission to a spinal injuries unit.

Only about 5% of spinal cord injuries occur in children, mainly following road trauma or falls from a height greater than their own, but they sustain a complete cord injury more frequently than adults.

Although the effect of the initial trauma is irreversible, the spinal cord is at risk from further injury by injudicious early management. The emergency services must avoid such complications in unconscious patients by being aware of the possibility of spinal cord injury from the nature of the accident, and in conscious patients by suspecting the diagnosis from the history and basic examination. If such an injury is suspected the patient must be handled correctly from the outset.

Causes of spinal cord injury — 126 new patient admissions to Duke of Cornwall Spinal Treatment Centre (1997–99):

Accidents	%
Road traffic accidents	45
Car, van, coach, lorry	16.5
Motorcycle	20
Cycle	5.5
Pedestrian	1.5
Aeroplane, helicopter	1.5
Self harm and criminal assault	6
Self harm	5
Criminal assault	1
Domestic and industrial accidents	34
Domestic — e.g. falls downstairs or from trees or ladders	22
Accidents at work — e.g. falls from scaffolding or ladders, crush injuries	12
Injuries at sport	15
Diving into shallow water	4
Rugby	1
Horse riding	3
Miscellaneous — e.g. gymnastics, motocross, skiing, etc	7