Epidemiology and Impact of Spinal Cord Injury in the Elderly: Results of a Fifteen-Year Population-Based Cohort Study

Wilson, Jefferson R.; Cronin, Shawna; Fehlings, Michael G.; Badhiwala, Jetan H.; Ginsberg, Howard J.; Witiw, Christopher D.; Jaglal, Susan

doi:10.1089/neu.2020.6985

Cited by 40 publications

(34 citation statements)

References 21 publications

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“…Present cohort study suggested that increased life expectancy was also accompanied by increased incidence of osteoporosis, spinal stenosis and high probability of fall-induced injuries, increasing the risk of SCI. 15 Falls and falls-induced injuries were common in elderly population and increased with age. Due to the decreased physical function and health condition, the elderly was more likely to fall and then have fractures, SCIs or other injuries.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Injury: The Global Incidence, Prevalence, and Disability from the Global Burden of Disease Study 2019

Ding

Wang

et al. 2022

Spine

145

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Study Design. A retrospective cohort study. Objective. The authors aimed to estimate the incidence, prevalence and years lived with disability (YLDs) of spinal cord injury (SCI) by location, sex, age, injury site and socio-demographic index (SDI) based on the data of the Global Burden of Disease Study (GBD) 2019. Summary of Background Data. GBD 2019 estimates the burden of 369 diseases and injuries worldwide in 2019 and the temporal trends in the past 30 years. SCI is estimated as a result of injury from various causes. Methods. A Bayesian meta-regression tool, DisMod-MR2.1, was used to produce the estimates. Estimated annual percentage change (EAPC) was calculated based on a linear regression mode of the age standardized rates and the calendar year to represent the temporal trends of the age standardized rates. Spearman rank order correlation was used to determine the correlation between SDI and the incidence and burden of SCI. Results. Globally, there were 0.9 [95% uncertainty interval (UI), 0.7 to 1.2] million incident cases, 20.6 (95% UI, 18.9–23.6) million prevalent cases and 6.2 (95% UI, 4.5–8.2) million YLDs of total SCI in 2019. The ASPR increased (EAPC, 0.1; 95% confidence interval, −0.01 to 0.2), while the age standardized incidence rate (ASIR) (EAPC, −0.08; 95% UI, −0.24 to 0.09) and age standardized YLD rate (ASYR) (EAPC, −0.08; 95% confidence interval, −0.24 to 0.09) decreased. Males had higher ASIR and ASYR, and the rate of incidence, prevalence and YLD increased with age. Spinal injuries at neck level caused higher ASYR than injuries below neck level. A positive correlation existed between SDI and ASIR (ρ=0.1626, P<0.05), while a negative correlation was observed between SDI and EAPC of ASYR (ρ=−0.2421, P<0.01). Conclusion. Conclusively, the incidence and burden of SCI has increased over the last 30 years. Males and the elderly were affected to a greater degree than females and younger individuals. Level of Evidence. Level III.

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Section: Discussionmentioning

confidence: 99%

Spinal Cord Injury: The Global Incidence, Prevalence, and Disability from the Global Burden of Disease Study 2019

Ding

Wang

et al. 2022

Spine

145

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“…14,22 In contrast to fracture-dislocation injuries, which are motor complete and for which there has generally been less controversy, tCSCI without fracture dislocation has posed multiple dilemmas for surgeons over the past half century, since Dr. Schneider's original description of the clinical syndrome of acute traumatic central cord syndrome. 17,62 These dilemmas continue to include, but are not limited to, operative versus non-operative management, optimal timing of surgery, operative technique, and extent of spinal cord decompression. 61,[63][64][65][66][67][68][69] That these questions remain unsettled at present is attributable largely to the fact that the overwhelming majority of these patients exhibit modest clinical improvement when managed according to several different strategies.…”

Section: Discussionmentioning

confidence: 99%

Trends in Demographics and Markers of Injury Severity in Traumatic Cervical Spinal Cord Injury

Aarabi

Albrecht

Simard

et al. 2021

Journal of Neurotrauma

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Over the past four decades, there have been progressive changes in the epidemiology of traumatic spinal cord injury (tSCI). We assessed trends in demographic and injury-related variables in traumatic cervical spinal cord injury (tCSCI) patients over an 18-year period at a single Level I trauma center. We included all magnetic resonance imaging-confirmed tCSCI patients ‡15 years of age for years 2001-2018. Among 1420 patients, 78.3% were male with a mean age 51.5 years. Etiology included falls (46.9%), motor vehicle collisions (MVCs; 34.2%), and sports injuries (10.9%). Median American Spinal Injury Association (ASIA) Motor Score (AMS) was 44, complete tCSCI was noted in 29.6% of patients, fracture dislocations were noted in 44.7%, and median intramedullary lesion length (IMLL) was 30.8 mm (complete injuries 56.3 mm and incomplete injuries 27.4 mm). Over the study period, mean age and proportion of falls increased ( p < 0.001) whereas proportion attributable to MVCs and sports injuries decreased ( p < 0.001). Incomplete injuries, AMS, and the proportion of patients with no fracture dislocations increased whereas complete injuries decreased significantly. IMLL declined ( p = 0.17) and proportion with hematomyelia did not change significantly. In adjusted regression models, increase in age and decreases in prevalence of MVC mechanism and complete injuries over time remained statistically significant. Changes in demographic and injury-related characteristics of tCSCI patients over time may help explain the observed improvement in outcomes. Further, improved clinical outcomes and drop in IMLL may reflect improvements in initial risk assessment and pre-hospital management, advances in healthcare delivery, and preventive measures including public education.

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“…Most of the included studies also only used animals that were quite young, with only one study comparing treatment effects in young versus old animals (Chaovipoch et al, 2005). Recent research indicated that the incidence of SCI among the elderly is increasing and that they have differing pathophysiological and functional outcomes relative to their younger counterparts with SCI, including a doubled risk of death (Wilson et al, 2020). It is important, therefore, that preclinical models examine age as an important co-variable in determining if estrogen and its compounds confer neuroprotection in SCI.…”

Section: Limitations Of the Included Studies And The Present Reviewmentioning

confidence: 99%

The neuroprotective effects of estrogen and estrogenic compounds in spinal cord injury

Shvetcov

Ruitenberg

Delerue

et al. 2022

Preprint

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Spinal cord injury (SCI) occurs when the spinal cord is damaged from either a traumatic event or disease. SCI is characterised by multiple injury phases that affect the transmission of sensory and motor signals and lead to temporary or long-term functional deficits. There are few treatments for SCI. Estrogens and estrogenic compounds, however, may effectively mitigate the effects of SCI and therefore represent viable treatment options. This review systematically examines the pre-clinical literature on estrogen and estrogenic compound neuroprotection after SCI. Several estrogens were examined by the included studies: estrogen, estradiol benzoate, Premarin, isopsoralen, genistein, and selective estrogen receptor modulators. Across these pharmacotherapies, we find significant evidence that estrogens indeed offer protection against myriad pathophysiological effects of SCI and lead to improvements in functional outcomes, including locomotion. A STRING functional network analysis of proteins modulated by estrogen after SCI demonstrated that estrogen simultaneously upregulates known neuroprotective pathways, such as HIF-1, and downregulates pro-inflammatory pathways, including IL-17. These findings highlight the strong therapeutic potential of estrogen and estrogenic compounds after SCI.

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Epidemiology and Impact of Spinal Cord Injury in the Elderly: Results of a Fifteen-Year Population-Based Cohort Study

Cited by 40 publications

References 21 publications

Spinal Cord Injury: The Global Incidence, Prevalence, and Disability from the Global Burden of Disease Study 2019

Spinal Cord Injury: The Global Incidence, Prevalence, and Disability from the Global Burden of Disease Study 2019

Trends in Demographics and Markers of Injury Severity in Traumatic Cervical Spinal Cord Injury

The neuroprotective effects of estrogen and estrogenic compounds in spinal cord injury

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