Spinal Cord Injury Center

Spinal Cord Injuries Are Not Just Caused by Trauma

When you think of spinal cord injury (SCI), traumatic events like a serious car accident may come to mind. While it’s true that car accidents are the leading cause of traumatic SCI, you may be surprised that non-traumatic diseases—such as a spinal tumor—can also cause SCI.

SCI involves damage to the spinal cord that temporarily or permanently changes how it functions. SCI is divided into 2 categories: traumatic or non-traumatic. Even if the cause of SCI is non-traumatic, that doesn’t lessen its impact or severity—the aftermath of SCI can have devastating effects on a person’s life.
Mountain biker is having a painful accident on a bikeFalls are the second most common cause of traumatic spinal cord injury.Traumatic Spinal Cord Injury

  1. Vehicle crashes: Car accidents are the leading cause of traumatic SCIs in North America, and they accounted for 38% of all traumatic SCIs between 2010 and 2014.
  1. Falls: Falls are the second-most common cause of traumatic SCIs, and they accounted for 31% of injuries between 2010 and 2014.
  1. Sports-related injuries: Sports and activity injuries cause anywhere from 10% to 17% of traumatic SCIs.
  1. Violent acts: Violent acts, such as a gunshot wound or stabbing, are another common cause of traumatic SCI.

Traumatic SCI occurs more often in men than women—nearly 80% of cases affect men. People of all ages may experience SCI, but certain activities tend to affect different age groups more. For example, high-impact events like car accidents and sports injuries tend to occur more often in younger people. On the other hand, traumatic SCI caused by a fall is more common in adults over age 60.

Regardless of the cause, traumatic SCI occurs most frequently in the cervical spine (about 60% of cases involve the neck), followed by thoracic spine (32% involve the mid-back). Only 9% of cases occur in the lumbosacral spine, or low back and tailbone.

Understanding the Traumatic Spinal Cord Injury Cascade
A traumatic SCI doesn’t simply damage your spinal cord at the point of initial impact. In traumatic SCI, the primary injury (that is, the initial traumatic event that caused the SCI) may damage cells and dislocate your spinal vertebrae, which causes spinal cord compression. The primary injury also triggers a complex secondary injury cascade, which causes a series of biological changes that may occur weeks and months after the initial injury.

During the secondary injury cascade, the following processes occur:

  • Glial cells and nerve cells in your spinal cord begin to die. Glial cells provide nutrients and other support to the nerve cells in your central nervous system, which consists of your brain and spinal cord.
  • The blood vessels in your spinal cord lose function, which reduces blood supply to the spinal cord. Inadequate blood supply is called ischemia.
  • Blood vessel injury exposes the spinal cord to inflammatory cells, leading to spinal cord swelling.
  • Inflammation of the spinal cord causes further spinal cord compression and progressively worsens the initial injury.

This cascade changes the spinal cord’s structure and how it normally operates. Ultimately, this secondary injury cascade may interfere with the spinal cord’s ability to recover itself. This means a person with traumatic SCI may experience permanent nerve pain and dysfunction because of their injury.

Non-Traumatic Spinal Cord Injury
Traumatic events aren’t the only causes of spinal cord damage—SCI can also be caused by non-traumatic diseases in the spine. Spinal tumors are the leading cause of non-traumatic SCI, but infections and degenerative disc disease can also damage your spinal cord.

Though most people connect traumatic events to SCI, non-traumatic causes of SCI are a much more likely cause. To highlight just how common non-traumatic cases are versus their traumatic counterparts, consider the incidence of traumatic SCI in North America: 39 cases per million people. On the other hand, the incidence of non-traumatic SCI is 1,227 cases per million people for Canada alone (data for the rest of North America is not available).

A Healthy Research Outlook to Improve Spinal Cord Injury Outcomes
Over the past 30 years, spine researchers have made great strides in developing successful protective and regenerative therapies to improve the health of the spinal cord and the survival rate of people with SCI—but the work is far from over. Current studies and clinical trials are examining innovative medical, surgical and cell-based treatments to further the medical community’s understanding of SCI, which will improve the quality of life and preserve a brighter future for people who experience these injuries.

Suggested Additional Reading
A special issue of the Global Spine Journal set forth guidelines for the Management of Degenerative Myelopathy and Acute Spinal Cord Injury, which is summarized on SpineUniverse in Summary of the Clinical Practice Guidelines for the Management of Degenerative Cervical Myelopathy and Traumatic Spinal Cord Injury.

 

Sources:
Ahuja CS, Wilson JR, Nori S, et al. Traumatic spinal cord injury. Nature Reviews Disease Primers. 3, 17018. https://www.nature.com/articles/nrdp201718. Accessed January 10, 2018.

Spinal Cord Injury. Facts and figures at a glance. National SCI Statistical Center (NSCI SC). 2017. https://www.nscisc.uab.edu/. Accessed January 10, 2018.

Updated on: 01/10/18
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Traumatic Spinal Cord Injury Facts and Figures

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