Trauma and Paraplegia

Abstract

Spinal cord injury (SCI) is a multibillion dollar annual health care problem in the United States and throughout the world (Green et al. 1987). Paralysing SCI represents a catastrophic disease associated with high morbidity and mortality. There are an estimated 250000–300000 spinal cord injured patients living in the United States. Approximately 10000–12000 new injuries occur annually, a rate of 5 per 100000 population (Thomas 1979; Kalsbeek et al. 1980). The majority of injuries occur in the second to third decade of life, with 80% of patients being less than 40 years of age and male (Young and Northrup 1979). Automobile accidents represent the most common mechanism of injury, with a growing number each year from motorcycle accidents. Injuries from falls, industrial, gunshot, agricultural and sporting accidents account for the remainder of these injuries. In recent years, however, there has been an increase in the number of hand-gun wounds, particularly in metropolitan areas (Green et al. 1981). The most frequently injured level is the mid to low cervical, with the thoracolumbar area ranking second. These represent the areas of greatest mobility of the spinal column. The National Spinal Cord Injury Data Research Center in Phoenix, Arizona reported that 53% of spinal cord injuries result in quadriplegia and 47% in paraplegia (Green et al. 1981). The mortality rate is estimated at 6% within the first six months of injury for patients treated at major SCI centres (Bracken et al. 1990). The morbidity is greater than 100%, since each SCI victim experiences one or more systemic complications associated with their paralysis.