This is a focused review on the subject of spinal cord injury. I'm Michael Priby. I'm the Chief of SCI Care at the Charlie Norwood VA Medical Center in Augusta, Georgia. I have no disclosures. Let's start with basic epidemiology and demographics. I'd like to point out that the demographics that you read about depend on the source, and in the United States we have at least two unique sources of spinal cord injury data. The first is from the model systems. The SCI model systems is funded by the National Institute for Disability and Independent Living and Rehabilitation Research. They provide competitive five-year grants to university-based systems of top-notch SCI centers around the country. These have an integrated trauma system, and currently there are 16 SCI model system centers funded. The VA SCI system has actually been around longer. This is funded through the VA Medical Center and is hospital-based. There is no integrated trauma system. These are non-competitive programs that are funded in the SCI centers. Currently there are 25 spinal cord injury centers in the VA system. Both model system and VA SCI system programs have CARFA-credited rehabilitation and both provide longitudinal care to people with with SCI. Much of the data that has been published is from the model system, and I will in this presentation also add some comparable data for the VA. In the United States, there is an estimated 54 cases per 1 million people per year, which gives approximately 17,000 new cases of spinal cord injury. This is traumatic spinal cord injury, and based on a study looking at 1993 to 2012, there are a lot more non-traumatic spinal cord injuries than traumatic spinal cord injuries in the country. The prevalence ranges anywhere between 250 to 360,000 people. As people with spinal cord injury age, the prevalence increases even if we decrease the incidence through prevention. Now the SCI model system data has typically has had younger individuals. The age at injury is currently 43 years, but historically this age had been much younger. It's only in the last decade or so that the the age of injury for the model systems has climbed up into the 40s. 74% are male, and the vast majority are described as non-Hispanic white, almost 60%. With the next group being non-Hispanic black, almost 23%, and then the third group being Hispanic origin at 13%. Comparing that to the VA system of care, again, considering the population, the VA only serves people who have been in the military, and therefore the gender makeup is approximately 95% male, and because of the aging population of the veterans, the average age at injury is 60 years. Interestingly, the VA describes individuals by race and does not include ethnicity, and so you can see the great preponderance of people with spinal cord injury in the VA system. Almost 62.5% are white, 30% are black, and much smaller percent are Native American, Asian, Native Hawaiian, or Pacific Islander, or unknown. The cause of injury also varies between these two systems of care. In the spinal cord injury model system, 39% are vehicular, 31% are falls, 13.5% are due to violence, 8% due to sports, and smaller percentages due to medical, surgical, or other traumatic causes. In the spinal cord injury system of care in the VA, falls are the number one cause of injury, followed by vehicular at a significantly smaller proportion than the model systems. Violence, 5%, sports, 6%, and other, 8%. The VA SCI system of care does not only provide care to people who are injured during military action, but to any veteran who is eligible for care in the VA system. The VA also serves a significant population of non-traumatic spinal cord injury. In fact, over half of the spinal cord injury population has a non-traumatic diagnosis. The number one cause is columnar degeneration. Cervical spondylosis with myelopathy is exceedingly common, either with or without a fall. The 47% here are people who had no trauma, but had columnar degeneration, and either surgery or no surgery, but have a myelopathy. Another 15% are due to infection, 10% arthritic changes, 8% vascular, and 8.3% tumor-related. As you can see, the population due to columnar degeneration explains why, on the previous slide, a large number of injuries due to falls, when people are aging with spinal stenosis, and a fall from standing can result in a traumatic spinal cord injury. Comparing the two systems also for neurologic level and extent of injury, we have two different ways of describing the neurologic level and extent of injury. The standard historical way is used by the model system of complete and incomplete, tetraplegia, and paraplegia. The VA system of care provides a singular approach in which it collapses the categories of those people with ASIA A, B, and C into categories of high tetraplegia, which is C1 through C4, low tetraplegia, C5 through C8, paraplegia, T1 through S5, and all ASIA D. When looking at the VA system of care, over half the population of the provided services in the VA are ASIA D, whereas 16% are high tetras, class A, B, or C, 6.9% are low tetras, and 21% are paras. Comparing to the model system, you can see incomplete tetraplegia makes up almost 50%, and I suspect if we were to compare apples to apples, these two populations may be quite similar. Incomplete paraplegia and complete paraplegia each make up over 19%, and complete tetraplegia a little over 12%. This data can be reviewed through the National Spinal Cord Injury Statistical Center through their facts and figures at a glance, and most of this data was obtained from the 2019 SCI data sheet. The National VA Spinal Cord Injury and Disorders Registry now provides us with the ability to compare spinal cord injury demographics and epidemiology, as well as functional outcomes for veterans served in this system.

spinal cord injury

demographics

epidemiology

United States

SCI Model Systems