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Study design: Literature review. Objectives: To map traumatic spinal cord injury (TSCI) globally and provide a framework for an ongoing repository of data for prevention. Setting: An initiative of the ISCoS Prevention Committee. Methods: The results obtained from the search of Medline/Embase using search phrases: TSCI incidence, aetiology, prevalence and survival were analysed. Stratification of data into green/yellow/red quality 'zones' allowed comparison between data. Results: Reported global prevalence of TSCI is insufficient (236-1009 per million). Incidence data was comparable only for regions in North America (39 per million), Western Europe (15 per million) and Australia (16 per million). The major cause of TSCI in these regions involves four-wheeled motor vehicles, in contrast to South-east Asia where two-wheeled (and non-standard) road transport predominates. Southern Asia and Oceania have falls from rooftops and trees as the primary cause. Highfall rates are also seen in developed regions with aged populations (Japan/Western Europe). Violence/ self-harm (mainly firearm-related) was higher in North America (15%) than either Western Europe (6%) or Australia (2%). Sub-Saharan Africa has the highest reported violence-related TSCI in the world (38%). Rates are also high in north Africa/Middle East (24%) and Latin America (22%). Developed countries have significantly improved TSCI survival compared with developing countries, particularly for tetraplegia. Developing countries have the highest 1-year mortality rates and in some countries in sub-Saharan Africa the occurrence of a spinal injury is likely to be a fatal condition within a year. Conclusion: Missing prevalence and insufficient incidence data is a recurrent feature of this review. The piecemeal approach to epidemiological reporting of TSCI, particularly failing to include sound regional denominators has exhausted its utility. Minimum data collection standards are required.

Study design: Survey of expert opinion, feedback, and development of final consensus. Objective: Present the background, purpose, development process, and results for the International Spinal Cord Injury (SCI) Core Data Set. Setting: International. Methods: A committee of experts was established to select and define data elements to be included in an International SCI Core Data Set. A draft core data set was developed and disseminated to appropriate organisations for comment. All suggested revisions were considered, and a final version of the core data set was disseminated again for approval and adoption. Results: The core data set consists of 24 variables, including basic demographic characteristics, dates of admission and discharge from initial acute and rehabilitation care, cause of injury, place of discharge, presence of vertebral fractures and associated injuries, occurrence of spinal surgery, and measures of neurological and ventilator status. Conclusion: Collection of the core data set should be a basic ingredient of all future studies of SCI to facilitate accurate description of patient populations and comparison of results across published studies from around the world.

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Surgery for patients with spinal metastases offers decreased pain and improved quality of life with low rates of surgical complications.

Spinal injuries are among the most devastating injuries associated with recreational sports. Snowboarding spinal injury patterns have not been described. During two seasons (1994 to 1995 and 1995 to 1996), 34 skiers and 22 snowboarders suffered serious spinal injuries (fracture or neurologic deficit or both) at two ski areas in British Columbia, Canada. Ski patrol records, the Provincial Trauma Database, and hospital records were reviewed. Injury rates were based on computerized lift-ticket data and a population estimate of 15% snowboarders (ski patrol observation). The incidence of spinal injury among skiers was 0.01 per 1000 skier-days, and among snowboarders was 0.04 per 1000 snowboarder-days. Mean age was 34.5 years for skiers and 22.4 years for snowboarders. Seventy percent of the skiers were men, whereas all of the snowboarders were men. Jumping (intentional jump > 2 meters) was the cause of injury in 20% of skiers and 77% of snowboarders. Neither age nor sex accounted for any significant portion of this difference. The rate of spinal injuries among snowboarders is fourfold that among skiers. Although jumping is the primary cause of injury, it is an intrinsic element of snowboarding. Until research defines effective injury-prevention strategies, knowledge of the risk of snowboarding should be disseminated and techniques for safe jumping should be taught.

Although the majority of patients improve to an AMS between 90 and 100, many have significant disability and are less functional than the general population. Significant predictive variables include the initial motor score, formal education, comorbidities, age at injury, and development of spasticity. An assessment of more than just the motor score is required to obtain an appreciation of the function and outcomes in this population.

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