Key facts
- More than 15 million people in the world live with spinal cord injuries.
- Most cases of spinal cord injury are due to trauma, including injuries caused by falls, traffic accidents or violence, and are therefore preventable.
- People with spinal cord injuries are at risk of developing secondary health conditions that can be debilitating, life-threatening, and can cause premature death.
- Spinal cord injury is associated with lower rates of school enrollment and economic participation, resulting in significant individual and societal costs.
- Effective prevention, treatment, rehabilitation, and ongoing health care are essential to reduce the global burden of spinal cord injuries.
Overview
The term 'spinal cord injury' refers to damage to the spinal cord as a result of trauma (such as falls and road traffic injuries) or non-trauma-related causes such as tumors, degenerative or vascular conditions, infections, toxins or birth defects.
The severity of the weakness associated with a spinal cord injury depends on the severity of the injury and its location in the spinal cord. Spinal cord injury results in complete or partial loss of sensory and/or motor functions below the site of the injury. Arm functions do not stop in the case of paraplegia, but they are damaged in the case of quadriplegia. Nervous system dysfunction can occur and have an impact on various functions at any level of injury.
Inadequate management of secondary impairments and health conditions associated with spinal cord injury often leads to premature death.
Spinal cord injury can limit the ability to perform daily activities, including walking, using the hands, physiological emptying of the bowel/bladder, or bathing and dressing. Restrictions are compounded by misconceptions, negative attitudes and physical barriers to basic mobility, restricting independence and full community participation. Spinal cord injury is a major cause of long-term disability, representing in 2021 more than 4.5 million years of life lost due to disability.
It should be noted that many limitations on performing activities and participating in meaningful areas of daily life result not from the health condition itself, but from insufficient or inappropriate access to medical care, rehabilitation services and assistive technologies, and from a heavy economic burden, as well as barriers that Involved in the physical, social and policy environments. For example, only 5% to 35% of people in the world who need them have access to wheelchairs.
Scope of the problem
Global estimates indicate that the number of people with spinal cord injury in 2021 was approximately 15.4 million.
Males are more susceptible to spinal cord injury than females, and the continuing rise in prevalence rates and years of life lost due to disability is attributed to this population group.
Life expectancy in people with spinal cord injury is closely linked to neurological impairment and preventable secondary health conditions. People with spinal cord injury often die early due to health system-related factors such as inadequate access to or poor quality of health services. The in-hospital mortality rate of people with spinal cord injury is approximately three times higher in low- and middle-income countries than in high-income countries.
Misconceptions, negative attitudes and barriers to mobility prevent many individuals from fully participating in society. Children with spinal cord injury are less likely than their peers to start school, and are less likely to advance in their academic lives after enrolling in school. Adults with spinal cord injury face the same barriers to economic participation, with unemployment rates exceeding 60%.
Many people with spinal cord injury, their caregivers and their families face serious social and economic consequences. Although current data underestimate the global cost of spinal cord injury, its economic burden is significant. Indirect costs (for example, loss of income) often exceed direct costs, which are highest in the first year after the onset of a spinal cord injury, with people with this injury bearing the bulk of the cost.
Signs and symptoms
Depending on the severity and location of their injury, people with a spinal cord injury may have the following signs and symptoms:
- Partial or complete loss of sensory and/or motor function (including respiratory muscle function)
- Impaired bowel, bladder, and sexual function
- Dysregulation of blood pressure, heart rate, and/or body temperature.
Spinal cord injury is often associated with a risk of complications, including debilitating and potentially life-threatening secondary health conditions, such as:
- The rant
- Pain (chronic)
- Urinary tract infections
- Pressure sores
- Respiratory complications
- Autonomic dysreflexia
- Deep vein thrombosis
- Osteoporosis.
Furthermore, people with spinal cord injury may exhibit clinical signs of depression, which negatively impacts functional improvements and their overall health.
The risk of death is highest during the first year after infection, and remains high compared to the general population. The level and severity of the injury, the timely availability of high-quality medical care, the method of transportation to the hospital following the injury, and the time required for hospitalization are important factors.
Causes, risk factors and prevention
Traumatic spinal cord injuries resulting from falls and traffic accidents constitute the leading cause of spinal cord injury, followed by those resulting from violence (including self-harm and attempted suicide) and work- or sports-related injuries. Emergencies can also lead to increases in cases of spinal cord injury. Earthquakes, for example, can cause increases in the incidence of spinal cord injuries resulting from blunt trauma, while conflicts may result in an increase in penetrating injuries. The incidence of non-traumatic spinal cord injury is also increasing, especially among aging populations, due to the increase in noncommunicable diseases such as tumors and degenerative and vascular health conditions that can cause spinal cord damage.
Effective interventions are available to prevent many causes of traumatic spinal cord injury. These interventions include improvements to road infrastructure, vehicles and people's road behavior to avoid traffic accidents, window guards to prevent falls, policies to address the harmful use of alcohol and access to firearms in order to reduce violence, as well as On domestic violence and suicide prevention strategies (including equitable strategies in mental health services). Preventing non-traumatic spinal cord injury includes early diagnosis and treatment of the underlying health condition.
Preventing, early diagnosis and treatment of secondary conditions associated with spinal cord injury is essential to increasing life expectancy.
Treatment, rehabilitation and therapeutic management
Timely provision of pre-hospital management, emergency and acute care, and rehabilitation is essential to ensure survival and recovery of optimal levels of functioning, in order to reduce the risk of long-term disability. Long-term management is indispensable to maintain level of performance and prevent secondary health conditions and premature deaths. Basic measures include:
- Timely and appropriate pre-hospital management: rapid identification of suspected spinal cord injury, rapid assessment of the injury and initiation of management, including spinal stabilization, as appropriate;
- Acute care (including surgery) appropriate to the type and severity of the injury, the degree of instability, the presence of nerve compression, and in accordance with the wishes of the person concerned and his or her family;
- Providing multidisciplinary rehabilitation services for acute, post-acute and persistent injury, including mental health services, in order to address existing impairments, improve functioning and ensure independence and integration into the community, including vocational reintegration and general well-being;
- Providing assistive products that enable individuals to carry out daily activities necessary to enhance performance and independence that they would otherwise not be able to perform;
- Providing continuous health care to detect and manage complications and reduce the risk of developing secondary health conditions;
- Gain specialized knowledge about spinal cord injury and develop skills among medical and rehabilitation care providers.
People with disabilities such as spinal cord injury continue to suffer from severe health inequities. In accordance with the Convention on the Rights of Persons with Disabilities, States parties must ensure that people with spinal cord injury have access to free or affordable health care that is equivalent in scope, quality and standard to that provided to others. Addressing inequalities is essential to fulfilling this mandate.
Self-care
Appropriate self-management is essential to manage the impairments associated with spinal cord injury, restore optimal levels of functioning, and prevent secondary health conditions. Self-management requires the necessary competencies to apply effective self-care strategies as independently as possible and follow a healthy lifestyle.
However, people with a more severe case of spinal cord injury often require ongoing care and support, provided mainly by informal carers. Challenges faced by caregivers include stress and strain resulting from the tasks they undertake, financial burden, social isolation, lack of community services and bereavement when losing loved ones. Caring for someone with a spinal cord injury may have an impact on the carer's health, well-being and social relationships. Effective caregiver support and self-care interventions for wellness can significantly reduce caregiver stress, improve quality of care, and enhance engagement of people with spinal cord injury.
Self-care interventions provided by health workers aim to enable people with spinal cord injury and their families to take care of their health, prevent secondary health conditions, maintain optimal levels of functioning, and enhance coping strategies.