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Chronic complications of spinal cord injury and disease

Authors
Gary M Abrams, MD
Marc Wakasa, MD
Section Editor
Michael J Aminoff, MD, DSc
Deputy Editor
Janet L Wilterdink, MD

INTRODUCTION

Spinal cord injury (SCI) is a common event; in the United States, the incidence of traumatic SCI is about 40 per million persons per year, with approximately 250,000 living survivors of traumatic SCI in July 2005 [1]. The prevalence of nontraumatic SCI is unknown, but it is estimated that it is three to four times greater than traumatic SCI [2]. SCI produces a wide variety of changes in systemic physiology that can lead to a number of complications, which rival the neurologic deficits in their impact on function and quality of life.

Medical complications after SCI are both common and severe. In the Model Spinal Cord Injury Systems Database, rehospitalizations occurred in 55 percent of patients in the first year after SCI and continued at a stable rate of about 37 percent per year over the next 20 years [3]. Genitourinary and respiratory complications and pressure ulcers were the most common reasons for hospitalization. Increased patient age and severity of the spinal cord lesion also impacted on the risk of complications requiring hospitalization.

This topic reviews the management of common complications of chronic SCI, whether due to trauma or other conditions. Acute manifestations and complications of SCI are presented separately. (See "Acute traumatic spinal cord injury" and "Disorders affecting the spinal cord".)

LIFE EXPECTANCY

Life expectancy is reduced among survivors of spinal cord injury (SCI). Mortality rates are highest in the first year. For patients surviving at least one year after traumatic SCI, life expectancy is approximately 90 percent of normal [1,4,5]. Higher neurologic level and severity of injury and older age at the time of SCI negatively impact survival.

The most common causes of death after traumatic SCI are diseases of the respiratory system followed by cardiovascular events [1,4]. In earlier decades (prior to 1972), urinary complications were the leading cause of death. The risk of suicide is also increased among patients with SCI [5]. (See 'Psychiatric complications' below.)

                                

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Literature review current through: Nov 2016. | This topic last updated: Tue Jul 15 00:00:00 GMT 2014.
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