Although traumatic spinal cord injury (SCI) is an irreversible, lifelong condition, recent advances in medical care—such as surgical interventions and new rehabilitation strategies—have increased patients’ chances of surviving and thriving after experiencing SCI. Despite this progress, individuals with SCI remain three times more likely to die in the first two years after injury than their healthy peers. Clinicians recognize that this high mortality rate represents a significant gap in health care for SCI, indicating an urgent need for new targeted treatments to improve outcomes among people with chronic SCI.
Before researchers can develop new SCI interventions, they need to understand the specific factors that put individuals at high risk for complications in the years following SCI. A research team addressed this question by studying mortality and post-injury complications in a group of 830 patients who were referred to the Brain and Spinal Research Center at the Tehran University of Medical Sciences between 2013 and 2017. The researchers collected data about each patient’s injuries, follow-up hospital visits, complications, and other demographic information.
They found that about 2.6% of SCI patients died in the years following their injury. Critically, only patients with cervical spine injuries died. The cervical spine is the portion of the spinal column that forms the neck, connecting the base of the skull to the upper back. This flexible column of seven discs protects the part of the spinal cord that helps the brain communicate with the entire body, so injuries to this area tend to be severe and often result in paralysis or death.
Among the patients who died in this study, most died as a result of sepsis caused by infected pressure ulcers. Also called bedsores, pressure ulcers are areas of damaged or dying tissue caused by immobility. This complication is common among people with paralysis, who tend to be bedbound or may spend long periods of time in seated positions. An estimated 85% of people with SCI—typically those who are paralyzed as a result of cervical spinal injuries—will experience bedsores at some point in their lifetime, increasing their risk of infection-related complications.
These findings indicate an urgent need for interventions to prevent and treat bedsores among people with limited mobility as a result of SCI. Although bedsores are relatively common among people with paralysis, these injuries can cause life-threaten septic infections when they are not adequately treated. Researchers can make significant progress towards improving outcomes in SCI patients by investigating new approaches to addressing bedsores among paralyzed individuals.
Ghajarzadeh M, Rahimi Foroushani A, Nedjat S, et al. Survival analysis in patients with chronic traumatic spinal cord injury. Iranian Journal of Public Health. (December 2019).