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Spinal cord injury, blunt and penetrating, neurogenic and spinal shock
Spinal cord injury (SCI) is a traumatic event that causes transient or permanent loss of normal sensory, motor, or autonomic function. The long-term sequelae can be devastating due to the financial burden as well as the psychological effects and physical dependency it places on the patient. There is an initial traumatic injury to the spinal cord from the impact that causes hemorrhages in the white and gray matter, axonal damage, and cellular membrane destruction. This is followed by a secondary pathophysiologic cascade of events that can cause additional injury. There is also the potential for additional direct injury if the spine is unstable. Acute SCI can significantly impair a patient’s quality of life, functional status, and social independence. Initial management is crucial to long-term survival and quality of life and is targeted at preservation of cord function together with prevention of avoidable complications.
Incidence
It has been estimated that 17,000 new SCIs occur in the United States each year. Most of these are caused by trauma to the spinal column, with motor vehicle accidents (36%–48%), falls (17%–21%), and violence (5%–29%) being the most common causes, but with sports and recreational activities also accounting for a large amount (17%–21%). According to the Centers for Diseases Control and Prevention, SCI costs the nation an estimated $9.7 billion each year. People with SCI are two to five times more likely to die prematurely than people without an SCI, with worse rates in those with poorer socioeconomic status. Patients are often young risk-takers, and injuries are more common in males (80%) and with greatest frequency of age occurring between 15 and 25 years of age. Males also represent nearly all (90%) of sports-related SCIs. Although the average age of SCIs is 38, the percentage of people older than 65 with an SCI is increasing.
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