Mortality of spinal cord injury

Poisson regression analyses were used to Interest in the pharmacologic treatment of acute spinal-cord injury dates back at least 20 years. The initial clinical practice guideline for Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury was published in 2000. Spinal cord injuries (SCIs) often lead to impairment of the respiratory system and, consequently, restrictive respiratory changes. Prevalence of comorbid and secondary conditions were evaluated and models were developed to explain the onset of secondary conditions, mortality and low quality of life (QOL). Background: We aim to assess the long-term trend of and identify risk factors for traumatic spinal cord injury (TSCI) mortality from 1981 through 1998 in the state of South Carolina (SC). Careful attention to the support of the pulmonary and cardiovascular systems can reduce the morbidity associated with acute spinal Functional outcomes in spinal cord injury rehabilitation per level of injury. Recognizing the lack of previous studies on mortality in chronic SCI, the purpose of this study therefore was to perform a descriptive analysis of the causes of death in patients It is well known that survival rates in subjects with spinal cord injury (SCI) are significantly lower than in the able-bodied population. The prevalence of traumatic spinal cord injury (SCI) worldwide is approximately 750 per million with an annual incidence that appears to be rising . With over 50 percent of persons with spinal cord injury admitted within three days of injury, the Regional Spinal Cord Injury Center has demonstrated a mortality rate of 5 percent and has significantly reduced the severe secondary complications of traumatic spinal cord injury. The risk factors for death were For older adults with spinal cord injuries (SCIs) related to cervical spine fractures, injury level and severity of SCI are risk factors for mortality, according to a study published in the August Key Words: Cardiovascular Disease, Spinal Cord Injury, Renal, Pulmonary S pinal cord injury (SCI) is a serious medical condition with considerable functional, psychological, and socioeconomic sequelae. 2007; 88 (3 Suppl 1): S62-70. Journal of Pediatric Surgery presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. Injury to the spinal cord via force transmission through the intact spinal column can also occur. However, the relationship between the progress of diabetes and PPARδ in SCI remains unknown. Spinal Cord 43: 408-416. Mr. For long-term SCI, morbidity and mortality from cardiovascular causes now exceeds that caused by renal and pulmonary conditions, the primary causes of mortality in previous decades. With recent progress in neurobiology, however, there is hope that drug administration could improve outcomes after SCI. The presence of both conditions further increases this risk. Arch Phys Med Rehabil. For isolated spinal cord injuries the mortality after one year is about 5-7%. Studies show the mortality rate for cardiovascular disease is 228 percent higher in those with a spinal cord injury. Some of the statistical data is summarized below. Fifty-three percent of spinal cord injury patients are left tetraplegic (partial or total paralysis of the arms, legs and torso iv PRESSURE ULCER PREVENTION AND TREATMENT FOLLOWING SPINAL CORD INJURY members based their recommendations on expert consensus. Learning as much as possible about spinal cord therapy can help a person decide on the best option to ease chronic pain in the back, neck, or limbs. Table 1: Key findings and recommendations of SCI related mortality. In those patients with incomplete spinal cord injury there is some preservation of motor and sensory functions below the level of compromise. S. individuals following spinal cord injury have resulted in markedly reduced mortality with survival rates of 85-90% (Karlsson). Comparative analysis of goal achievement during rehabilitation for older and younger adults with spinal cord injury. Spinal cord trauma can be caused by any number of injuries to the spine. It is well known that survival rates in subjects with spinal cord injury (SCI) are significantly lower than in the able-bodied population. If a patient survives the first 24 hours after spinal cord injury, the likelihood of survival for ten years is approximately 75-80%. The program is primarily funded by the Brain and Spinal Cord Injury Program Trust Fund, as outlined in section 381. † Correction of hypotension in spinal cord injury (systolic blood pressure , 90 mm Hg) when possible and as soon as possible is recommended. • Among the leading causes of death were malignant neoplasms, cardiovascular disease and suicide. 8). To identify predictors of early mortality following traumatic spinal cord injury (TSCI). The panel was conscientious in identifying areas where knowledge gaps exist so that future Spinal Cord Infarction - Etiology, pathophysiology, symptoms, signs, diagnosis & prognosis from the Merck Manuals - Medical Professional Version. AU - Carter, Rickey E. mortality in spinal cord injury is evolving, precise estimates are still not available for expectations of life and health following a spinal cord injury. The morbidity and mortality occurring during 25 years following spinal cord injury were analyzed. They can result from motor vehicle accidents, falls, sports injuries (particularly diving into shallow water), industrial accidents, gunshot wounds, assault, and other causes. Participants were 8,157 adults with traumatic SCI who were enrolled in a SCI Model Systems facility after 1973. Data and statistics were obtained from the National SCI Statistical Center and the National Center for Health Statistics. Conclusion: The SMRs show that life expectancy is reduced in chronic spinal cord injury in Norway, more for women than for men. INTRODUCTION. Mortality remained higher for people with SCI than for the general  Download Table | Complications associated with Spinal Cord Injury from publication: Complications and causes of death in spinal cord injury patients in Nigeria  25 Dec 2015 Why Are Spinal Cord Injury Survivors Vulnerable to Respiratory Infections? to make respiratory infections the most common cause of death. . [1] The acute treatment of patients with spinal cord injury has always focused on the injury itself and on the Eighty percent of spinal cord injuries occur in males aged 15 to 35. Mortality and longevity after a spinal cord injury: systematic review and  The aim of treatment in acute traumatic spinal cord injury is to preserve residual neurologic and pulmonary oedema) that are the main cause of morbimortality. AU - Kirke Rogers, W. Garber, MA, OTR, FAOTA, return to spearhead the revision of this critically important topic. The incidence of SCI in the United States is estimated to be 30–40 cases per 1 million inhabitants. Puget Sound Health Care System; Associate Professor, Department of Rehabilita tion Medi-cine, University of Washington, Seattle, Washington 98108. Spinal Cord Injury Update Fall 2012: Volume 21, Number 3 Literature Review. •Maintenance of mean arterial blood pressure at 85 to 90 mm Hg for the first 7 days after acute spinal cord injury to improve spinal cord perfusion is recommended. Collaborative Module Research Projects Equity and Quality in Assistive Technology for Individuals with Spinal Cord Injury 2. The risk of mortality after fractures in SCI is unknown. However, secondary mechanisms of physiologic or anatomic transection of the spinal cord that results in temporary loss or depression of all or most spinal reflexes below the level of injury a) decreased reflexes, loss of sensations b)flaccid paralysis below the level of injury c)may occur within minutes and can last from days to months Keywords: mortality; spinal cord injury; survival analysis Introduction Long-term survival following spinal cord injury (SCI) has received a great deal of attention in recent years. As many as 85% of individuals with SCI above T6 experience autonomic dysreflexia (Trop and The National Spinal Cord Injury database in the United States, confers approximately 40 cases of spinal cord injuries per million population, or an approximated 12,000 cases per annum. These funds are appropriated to the department for the purpose of providing the cost of care for brain or spinal cord injuries as a payor of last resort to residents of this state. e. The Brown-Sequard syndrome results from a hemisection lesion of the spinal cord. Extracted from Historical Lifetime Costs, NSCISC Spinal Cord Injury Facts and Figures at a Glance, 2019 SCI Data Sheet. Injury to the cauda equina is included in the definition, but other isolated injuries to nerve roots are excluded . Abstract: Study estimated bladder cancer mortality in people with spinal cord injury (SCI) compared to the general population. , in the neck. ACI Network Manager, State Spinal Cord Injury Service, Chatswood, NSW, Australia, . Garshick E, Kelley A, Cohen SA, Garrison A, Tung CGet al. Methods Patients were identified from hospital records. (2005) A prospective assessment of mortality in chronic spinal cord injury. “It’s important for quality of life, mental health. The greatest frequency of spinal cord injuries is between ages 15 and 25 years, with a male to female ratio of 4:1. 2003 Feb. Related Pages. 108 Survivors of TSCI Spinal Injury & its Management Spinal Cord Injury Cutting, compression, or stretching of the spinal cord Causing loss of distal function, sensation, or motion Caused by: Unstable or sharp bony fragments pushing on the cord, or Pressure from bone fragments or swelling that interrupts the blood supply to the cord causing ischemia. 1 Several studies have been performed to identify risk factors which impact life quality and survival time. Presented on June 9, 2009, by Rina Reyes, MD, Medical Director, UW Medicine SCI Rehabilitation Program and Assistant Professor, UW Department of Rehabilitation Medicine, and Ivan Molton, PhD, Clinical Psychologist and Acting Assistant Professor, UW Department of Rehabilitation Medicine. in both cardiovascular and noncardiovascular mortality. 6. Although the role of corticosteroids in the acute management of traumatic spinal cord injury is still controversial, we do not advocate their use. Respiratory impairment following spinal cord injury (SCI) is more severe in high cervical injuries, and is characterised by low lung volumes and a weak cough secondary to respiratory muscle weakness. CONCLUSION: This study found substantial variation in mortality and longevity within the SCI population, compared to the general population, and between WHO regions and country income level. AU - Mangold, Therese 1 Nov 2018 Originally the leading cause of death in patients with spinal cord injury who survived their initial injury was renal failure, but, currently, the  13 May 2015 Background/Aims: Mortality and longevity studies of spinal cord injury (SCI) are essential for informing healthcare systems and policies. Acute spinal cord injury occurs worldwide, with an annual incidence of 5–40 cases per million. Primary injury results from acute mechanical trauma, compression by a space-occupying lesion, or a vascular insult. A. T1 - A prospective study of health and risk of mortality after spinal cord injury. Methods We examined the abstracted data from the Japanese Diagnosis Procedure Combination database, and included patients with ICD-10 code S141 who were admitted on an emergency basis between 1 July and 31 December in 2007–2009. 2–7 These epidemiologic studies are important to determine specific survival estimates within subgroups, assess the societal economic burden A 2006 study by Strauss and colleagues reported that among patients with spinal cord injury, during the critical first 2 years following injury, a 40% decline in mortality occurred between 1973 Objective To study mortality and causes of death in an unselected geographically defined cohort of patients with traumatic spinal cord injury (TSCI), 1952–2001. 14 Jun 2018 For the assessment of factors related to mortality and other outcomes . Spinal Cord. Bladder cancer mortality was not significantly increased for ventilator users, those with motor incomplete injuries, or those injured less than 10 years. Journal of Neurology, Neurosurgery & Psychiatry, 2010. This male preponderance decreases beyond age 65, at which age falls become the most common mechanism of spinal cord injury. J Neurotrauma. A central cord syndrome is associated with greater loss of upper limb function compared to the lower limbs. To date, effective therapies for SCI have not been established. Data of patients with acute traumatic spinal cord injuries were collected in specialized spinal cord injury care centers nationwide. Traumatic spinal cord injury is defined as an acute injury of the spinal cord which results in a varying degree of paralysis and/or sensory disorder . PY - 2016/3/1. Objective. A further 39% were due to a land transport crash. Schilero a ,b d∗, Ann M. The good news is that life expectancy for spinal cord injury patients has significantly increased over the past decades. 00-3. 8 deaths per year). Kennedy P, Evans MJ, Berry C, Mullin J. Traumatic spinal cord injury is a relatively rare injury in Denmark but may result in serious neurological consequences. This document will use the term traumatic brain injury (TBI) when referring to head injuries. People who experience a traumatic spinal cord injury have lower life expectancies than people who do not have an SCI. Methods This study uses population-based data collected in the Swiss Spinal Cord Injury Cohort (SwiSCI) study, which covers all specialized rehabilitation centres. Now, life expectancy is much better, hovering just below the average for the general population. More than 10% of trauma patients sustain spinal injury and they have a higher mortality rate compared to other traumas[1]. TY - JOUR. #StopBullying. Pouw, [], and Sven Hirschfeld. GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. 07 (1. ” Approximately 680000 citations were acquired. Anterior spinal artery syndrome (also known as "anterior spinal cord syndrome") is syndrome caused by ischemia of the anterior spinal artery, resulting in loss of function of the anterior two-thirds of the spinal cord. A randomized double-blind clinical trial was conducted to compare neurological and functional recovery and morbidity and mortality rates 1 year after acute spinal cord injury in patients who had received a standard 24-hour methylprednisolone regimen (24MP) with those in whom an identical MP regimen had been delivered for 48 hours (48MP) or those who had received a 48-hour tirilazad Nursing care planning and goals for patients with spinal cord injuries include: maximizing respiratory function, preventing injury to the spinal cord, promote mobility and/or independence, prevent or minimize complications, support psychological adjustment of patient and/or SO, and providing information about the injury, prognosis, and treatment. Summary of Background Data. The Brain and Spinal Injury Center score: a novel, simple, and reproducible method for assessing the severity of acute cervical spinal cord injury with axial T2-weighted MRI findings. Branco BC, Plurad D, Green DJ, Inaba K, Lam L, Cestero R, Bukur M, Spinal cord injury Spinal cord injury (SCI) is rare with complex multisystem impairments which will result in some degree of loss or reduction in voluntary muscle activity, sensory deprivation and disruption of autonomic function related to the level and severity of the cord damage. Predictors of mortality in veterans with traumatic spinal cord injury. Limited information is available on factors associated with early mortality following TSCI. 5 increased risk. Non-English-language citations were excluded, as were nonhuman experimental studies. According to the World Health Organization, around 250,000 to 500,000 people suffer from a traumatic possible after acute spinal cord injury. Physicians were well aware of the various consequences of spinal cord injury (SCI), yet were unable to successfully manage any of these to have a measurable impact on the injured person’s life. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Mortality is significantly higher during the first year after injury, especially for those with higher-level injuries. are living with a spinal cord injury (SCI). Background. Cause-specific SMRs and risk indicators suggest that the high mortality rates after spinal cord injury to a certain degree are related to preventable aetiologies. 14 It has four characteristic mechanisms. Traumatic spinal cord injuries (TSCI) remain a serious public health and social problem. 1 deaths). AU - Cortez, Ricardo. Because it is the first nerve of the spinal cord, injury to the C1 nerve will result in impaired motor and sensory function throughout your entire body Mortality after traumatic spinal cord injury: 50 years of follow-up. PY - 2007/3/1. Mortality rates from injuries are higher for people from poorer economic backgrounds than those with higher incomes (according to the World Health Organization [WHO]), and health care professionals and organisations dealing with people with disabilities experience that individuals with spinal cord injury (SCI) in low income countries face serious challenges in their daily lives. The Spinal Cord Injury Zone website is a not-for-profit Spinal Cord Injury educational Knowledge Base. The immediate treatment of SCI is stabilization of the spine to prevent any further injury to the spinal cord. The treatment of spinal cord injury has Special Interest Meeting on Spinal Cord Injury Monitoring brain physiology in traumatic brain injury has become familiar. (See also Overview of Spinal Cord Disorders and Immediate care for spinal trauma. . To describe pre-hospital, emergency department and acute care assessment and management practices of senior clinicians for patients with acute traumatic spinal cord injury (TSCI) across Australia; and to describe clinical practice variation. Spinal cord injury is a mortal condition and has been recognised as such since antiquity. 21) and 2. J Neurol Neurosurg Psych 81: 368-373. Our goal is to inform the global EM community with timely and high yield content about what providers like YOU are seeing and doing everyday in your local ED. Introduction Recent studies demonstrate that cardiovascular diseases and associated complications are the leading cause of morbidity and mortality in individuals with spinal cord injury (SCI). What goes wrong in Spinal Cord Injury! The human spinal cord is a fragile bridge connecting brain with the other organs of the body. Steroid treatment in the early hours after the injury is aimed at reducing the extent of permanent paralysis during the rest of the patient's life Study Design. ) Compression is caused far more these two mortality rates (crude mortality rate and /-lx) are extremely close in absolute values_ As noted in the DeVivo et al. The National SCI Database is a prospective longitudinal multicenter study that currently captures data from an estimated 6% of new SCI cases in the U. Objective To examine the magnitude of the adverse impact of high-dose methylprednisolone treatment in patients with acute cervical spinal cord injury (SCI). 8% are male. For decades, prehospital spinal stabilisation with a rigid cervical collar and a hard backboard has been considered to be the most appropriate procedure to prevent secondary spinal cord injuries during patient transportation. risk for injury a nursing diagnosis approved by the North American Nursing Diagnosis Association, defined as the state in which a person is at risk for injury as a result of environmental conditions interacting with the individual's adaptive and defensive resources. The model provides an advantageous platform for studying mechanisms of adaptive plasticity that underlie spontaneous functional recovery. Includes a table showing the expected level of independence after complete SCI. Patients with spinal cord injury usually have permanent and often devastating neurologic deficits and disability. The completeness of a spinal cord injury relates to the amount of neurological function that is retained below the level of injury. Anterior cord syndrome occurs when the injury affects the anterior spinal tracts, including the vestibulospnal tract. I told him that there have been many studies and the results should be readily available through the published literature. Acute spinal cord injury is often associated with alterations in pulmonary and cardiovascular function that require treatment in the intensive care unit. The purpose is to generate data from this group of subjects pertaining to physical activities and the secondary consequences of using a wheelchair, to 43 Bracken MB, Shepard MJ, Holford TR, et al. AU - Wall, Barry. In the United States, there are over 200,000 men with spinal cord injuries (SCIs) who are at risk for lower limb fractures. 2013 Jul 30. The impact of specialized centers of care for spinal cord injury on length of stay, complications, and mortality: a Most spinal cord injury patients are in their teens or twenties. Objective: To identify and quantify  3 Jul 2017 Traumatic spinal cord injuries (TSCI) pose a significant burden globally, while existing epidemiological data–especially on population  A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent But it was not until Aulus Cornelius Celsus, born 30 BC, noted that a cervical injury resulted in rapid death that the spinal cord itself was implicated in  19 Jul 2013 Study design. Simon JK, Lazareff JA, Diament MJ, Kennedy WA. Learn what you can do to without spinal cord injury-high association with a complete spinal cord injury because of narrow thoracic canal • Thoracolumbar junction is where the inflexible thoracic spine meets the strong lumbar spine making it an area vulnerable to injury In 2015–16, 253 newly incident cases of traumatic spinal cord injury (SCI) due to external causes were reported to the Australian Spinal Cord Injury Register. Hagen EM, Lie SA, Rewkand T, Gilhus NE, Gronning M (2010) Mortality after traumatic spinal cord injury: 50 years of followup. What is added by this report? During 2005–2014, a total of 28 traumatic brain and spinal cord injury deaths in high school and college football were identified (2. What Causes Spinal Cord Injury? Traumatic spinal injury (TSI) means injury to the spinal column, spinal cord, or both. Resulting Many of these associated injuries are fatal. Injury and Violence Prevention and Control. 79, Florida Statutes. The report con - tains the best available scientific evidence about strategies to reduce the incidence of spinal cord injury, particularly from traumatic causes. 2003; 41: 44-52. (20) Review of 960 males with SCI rehabilitated during the period of 1965 to 1995 in Japan. emDOCs subscribes to the Free Open Access Meducation initiative. Main Outcomes and Measures Age- and sex-stratified incidence of acute traumatic spinal cord injury; trends in etiology and in-hospital mortality of acute traumatic spinal cord injury. On top of this, an estimated 11,000 SCIs occur each year, most of which are caused by trauma to the vertebral column. Infant Mortality and Low Birth Weight Rates Compared to Expected Rates by County and Healthy Start Coalition Areas These papers compare county infant mortality rates and low birth weight percentages to the rates and percentages that would be expected for each county and Healthy Start Coalition Area. One of the inevitable complications of spinal cord injury (SCI) is the associated osteoporosis that occurs predominantly in the pelvis and the lower extremities (see the image below). Pulmonary function and spinal cord injury Gregory J. Results In 1993, the estimated incidence of acute spinal cord injury was 53 cases (95% CI, 52-54 cases) per 1 million persons based on 2659 actual cases. The aim of this study was to calculate the age-standardized population mortality rates attributable to TSCI in 22 European countries, along with the pooled age-standardized mortality rate attributable to TSCI in Europe. Spinal cord injury, Australia 2015–16 1 1 Introduction Spinal cord injury (SCI) from traumatic causes imposes a heavy physical, psychological and economic burden on the injured people, their families and society because it often results in a high level of long-term disability and morbidity and an increased mortality risk. Intramedullary abscess of the spinal cord in children: a case report and review of the literature. N2 - Acute spinal cord injury (SCI) is a devastating event with high mortality and, among survivors, a high degree of morbidity due to both motor and sensory deficits. People who sustain spinal cord injuries in low- and middle-income countries are vulnerable to life-threatening complications after discharge. 6-fold increased risk of death, C4 to C5 injuries a 2. More than half of all spinal cord injuries occur in the cervical area, i. Retrospective cohort study. To estimate excess mortality and life years lost in a Swiss cohort of individuals with traumatic spinal cord injury (TSCI). This article outlines the initial management of acute traumatic spinal cord injuries in adults. Additionally, the latest report from the National Spinal Cord Injury Database (NSCIDB) indicates the main causes of death in persons  9 Jun 2009 The primary causes of death in the SCI population are respiratory Spinal cord injury increases your risk for shoulder dysfunction, early  7 May 2019 An elderly man sustained a cervical spinal cord injury after a fall down the . 2004; 42: 665-673. Improvements in the quality of care over the last few decades partially reflect specialized medical centers that focus on the acute treatment and rehabilitation of patients with SCI and are best equipped to provide the magnitude of service these patients require. Spinal cord injury occurs through two pathways: primary and secondary. Spinal cord injury levels can be expressed in many ways and it is important to understand the correlations. Autonomic dysfunction and early-onset sleep disordered breathing compound this respiratory compromise. 162-164 Compared with spinal cord injuries in the thoracic cord or lower, patients with C1 to C3 injuries have a 6. Although there have been major advances in neurological treatment for SCI, the mortality rate for (HealthDay News) – For older adults with spinal cord injuries (SCIs) related to cervical spine (C-spine) fractures, injury level and severity of SCI are risk factors for mortality, according to Changes in the peroxisome proliferator-activated receptors-δ (PPARδ) expression in rats after spinal cord injury (SCI) have been previously reported. Several studies have been   This study analyzed the mortality in 1453 spinal cord injured patients admitted Keywords: tetraplegia; paraplegia; standardised mortality ratio; survival rate; life  19 Nov 2013 WHO fact sheet on spinal cord injuryprovides key facts, understanding, demographic trends, mortality, health economic consequences,  trends in mortality and causes of death among persons with spinal cord injury. Methods:We performed a retrospective observational analysis of NTSCI cases treated at a First and foremost, a spinal cord injury (SCI), refers to damage of the spinal cord or specific nerves located at the spinal canal’s end. Spinal cord injury often has permanent consequences for the function of body parts below the site of injury, the extent of which depends on whether the injury is incomplete, leaving some degree of sensation and movement, or Purpose: To find out the average survival rate following Spinal Cord Injury (SCI) in Bangladesh. This has an important bearing in marking the level of injury and correlating with the anatomy. of mortality after spinal cord injury. Y1 - 2007/3/1. tilt and recline angles for people with spinal cord injury. The victims are often young, the injury debilitating, and the effects devastating and incalculable. 1,2 After incurring spinal cord injury (SCI), the individuals’ longevity declines significantly. Titles and abstracts of 641 manuscripts were reviewed, 589 on the topic of steroids and human SCIand 52onthetopicofGM-1gangliosideandhuman spinal cord injury. National Spinal Cord Injury Association Resource Center Factsheet #2: Spinal Cord Injury Statistics Although there is more information available about people who have a spinal cord injury than ever before, much of it is incomplete. With suspected spinal cord or vertebral injury, the patient should be immediately immobilized as an estimated 3 to 25% of injuries to the spinal cord occur during transport or resuscitation. x We devised a novel trigone-based sizing method, setting the trigones at 1/4 of annular circumference, and used it for mitral annuloplasty in patients with mitral regurgitation (MR). FDA approves innovative gene therapy to treat pediatric patients with spinal muscular atrophy, a rare disease and leading genetic cause of infant mortality Regulatory Status. Neurologic recovery after traumatic spinal cord injury: data from the Model Spinal Cord Injury Systems. To investigate the causes of death in patients who were ≤50 years at the time of traumatic spinal  14 Mar 2017 mortality risk factors and estimate current life expectancy. However, the optimum timing of early surgical treatment (within 24 h or 72 h after injury) is still controversial. Spinal cord injury typically occurs in males at the peak of their productive lives. 12,13 Primary injury occurs mechanistically, at the time of injury, and is irreversible. PURPOSE: To estimate the bladder cancer mortality in persons with spinal cord injury (SCI), as compared to the general population. In about 2500 BC, in the Edwin Smith papyrus, Egyptian physician accurately described the clinical features of traumatic tetraplegia (quadriplegia) and revealed an awareness of the awful prognosis with the chilling advice: “an For thousands of years, injury to the spinal cord was synonymous with death, either instantly or after a period of great suffering. Traumatic spinal cord injury (TSCI) may cause physiological dysfunctions and a range of complications in different body systems. The management of cervical spinal cord injury (SCI) has changed drastically in the last decades, and surgery is the primary treatment. The articles previewed below were selected by the editors because they include potentially useful information on the diagnosis or management of spinal cord injury and its complications. patients following acute spinal cord injury is recommended. Objective. 0 (EQuATE) The objective of this project is to investigate the equity and quality of assistive technology (AT) provision and outcomes for individuals with spinal cord injury (SCI). Bene®ts of early patients with spinal cord injury have reduced life admission to an organised spinal cord injury care system. This is a system of tests used to define and describe the extent and severity of a patient’s spinal cord injury and help determine future rehabilitation and recovery needs. METHODS: We analyzed data from the TSCI surveillance system in SC. An excellent review of the literature and comprehensive study of SCI survival using data from the US Spinal Cord Injury Model Systems1 describes the changes over In the meantime, patients with spinal cord injury with kidney disease should be recognized as having a significant risk of mortality, and potentially modifiable comorbidities in these patients Traumatic spinal cord injuries (TSCI) pose a significant burden globally, while existing epidemiological data–especially on population mortality–are limited. Given the impact of SCI on the individual and society, it is clear that effective therapies aimed at reducing the extent of tissue destruction and improving neurologic outcomes after the initial spinal cord trauma are urgently needed. Dolbow DR, Gorgey AS, Ketchum JM, Moore JR, Hackett LA, Gater DR. Review of published reports. Methods. A cohort of 230 patients was selected from the Vietnam Head and Spinal Cord Injury Study Registry meeting the following criteria: (1) survival beyond triage (72 hours); (2) significant myelopathy; and (3) availability of medical records. AU - Krause, James S. While neuroprotection studies in TBI failed in all aspects, success was achieved in reducing mortality/morbidity by applying BTF guidelines on monitoring and management of secondary insults. Life expectancy after spinal cord injury: a 50-year study JW Middleton1, A Dayton2, J Walsh2, SB Rutkowski3, G Leong3 and S Duong2 Study design: Cohort of incident cases from 1955 to 2006. 53 (2. Los Angeles, CA CONAL WlLMOT, MD Chairman Department of Physical Medicine and Rehabilitation Santa Clara Valley Introduction. Y1 - 2016/3/1. Pediatr Infect Dis J. 3. Objective: To identify and quantify  trends in mortality and causes of death among persons with spinal cord injury. Rajah’s lawyer mentions that Mr. Figure 1(a) Type of Injury Alabama Head and Spinal Cord Injury Registry (AHSCIR) Acute spinal cord injury (SCI), whether traumatic or nontraumatic in etiology, has a tremendous cost not only for patients and families, but also for society as a whole. All patients with pain along the spine or paresis/paralysis should be assumed to have spinal cord injuries until appropriate evaluation can be completed. Currently in the United States there are approximately 200,000 people are living with spinal cord injuries or spinal dysfunction spinal cord injury is preventable; that spinal cord injury is survivable; and that spinal cord injury need not prevent good quality of life and full contribution to society. Abnormal arterial stiffness, defined by a carotid–to-femoral pulse wave velocity (cfPWV) ≥10 m/s, is a recognised risk factor for heart disease in Interest in the pharmacologic treatment of acute spinal-cord injury dates back at least 20 years. Mortality and causes of death after traumatic spinal cord injury in Estonia Article (PDF Available) in The journal of spinal cord medicine 36(6) · May 2013 with 101 Reads How we measure 'reads' A spinal cord injury (SCI) is defined as damage to the spinal cord caused by an insult resulting in the transient or permanent loss of usual spinal motor, sensory, and autonomic function. The incidence of traumatic SCI is approximately 11,000 new cases each year in the United States, 1 with a prevalence of 191,000. N2 - Acute spinal cord injury is a devastating disease with enormous repercussions, not only for the victims and their families but for society as a whole. Spinal cord injury patients face many serious health problems besides paralysis. A spinal cord injury at the lumbar level, in contrast, would not affect neurological function in the areas of the body corresponding to the cervical or thoracic levels (arm function would be intact, for example). Spinal cord injury (SCI) is an important contributing factor to morbidity and mortality in the U. In order to derive these estimates, information about mortality and health must be combined into a single estimate. Relieving pain with spinal cord stimulation has some drawbacks. Spinal Cord Injury. 15 The most common is impact that causes persistent compression of the spinal cord by extradural elements. While historically spinal cord injury has been associated with very high mortality rates, the work of the American Neurosurgeon Dr Our purpose was to identify preoperative and intraoperative predictors of early mortality, spinal cord injury, or acute intestinal ischemia after repair of type IV thoracoabdominal aneurysm (TAA IV) as a basis for optimizing surgical indications and techniques. H. Listed below are five little-known facts about spinal cord injury (SCI), with a focus on its fascinating history. Spinal cord injury (SCI) produces a wide variety of changes in systemic physiology that can lead to complications over time. Methods: We analyzed data from the TSCI surveillance system in SC. RATIONALE A cute traumatic spinal cord injury is frequently associ-ated with systemic hypotension. Disease progression including natural history, disease phases or stages, and disease trajectory – clinical features and presentation over time Spinal Cord Injury. Spinal Cord Injury 8. Epidemiology. Karlet, CRNA, PhD Spinal cord injuries are not as common as many other types of injuries. Diagnosis is by MRI. spinal cord injury -- relations to gender, spinal level, completeness, and age at the time of injury. Results/Conclusion. The C3, C4, and C5 vertebrae form the midsection of the cervical spine, near the base of the neck. Previous epidemiological studies of the incidence and outcomes of traumatic brain injury (TBI) and spinal cord injury (SCI) have been limited by focusing on certain subpopulations, including only select injuries, or by providing estimates only for areas of the world with accessible data. 2005). 1 As the mortality associated with TSCI declines,2 the number of people living with the condition is increasing, contributing to significant social and economic costs. Rabadi MH, Mayanna SK, Vincent AS. Complex spinal surgical procedures may be performed to realign a "broken" spine and provide the spinal cord with the optimal environment to regenerate. Marit Grønning. This article describes a method for generating a reproducible spinal cord compression injury (SCI) in the neonatal mouse. The number of spinal cord injuries per year has remained fairly stable over the last two decades, with nearly 12,000 occurring each year mostly from sports injuries, car accidents and other forms of traumatic injury. 2 In an earlier trial (the National Acute Spinal Cord Injury Study, or NASCIS 1) we compared a Spinal cord injury, any of various conditions caused by damage to the tract of nerves that extends from the base of the brain through the canal of the spinal column. injury to the cervical spinal cord leading to impairment of function in the arms, trunk, legs, and pelvic organs paraplegia injury to the thoracic, lumbar or sacral segments leading to impairment of function in the trunk, legs, and pelvic organs depending on the level of injury. It is a different experience compared with painkillers or other pain control techniques. The authors undertook this study to evaluate the incidence of spinal cord injury (SCI) in geriatric patients (≥ 70 years of age) and examine the impact of patient age, extent of neurological injury, and spinal level of injury on the mortality rate associated with traumatic SCI. Patients with a spinal cord injury should receive permissive hypertension (mean arterial pressure >85 mmHg) for 7 days after the injury. This clinical trial aims to assess the efficacy of a microelectrode-array implant in a tetraplegic's brain motor cortex that is used to translate thought into physical action—without the mediation of the spinal cord. Arch Phys Med Rehabil 1999;80:1411-19. Introduction. While the incidence rates of TSCI are relatively low, it is a high-cost condition which has been associated with high mortality rates []. ASIA/ISCoS Exam and Grade. Cardiovascular disease is a growing concern for the spinal cord–injured (SCI) population. to increased mortality in the chronic phase of spinal cord injury (6). 92) in paraplegics. Body surfing accidents (BSA) can cause cervical spinal cord injuries (CSCIs) that are associated with near-drowning (ND). Severe systemic injuries, traumatic brain injury, and medical comorbidity also increase mortality. Anterior cord syndrome: Impacting the front of the spinal cord, this injury impacts the cord’s motor and sensory pathways, making movement increasingly difficult and lessening sensitivity. 9 Kirshblum SC, Priebe MM, Ho CH, et al. GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators. The submersion injury from a ND can result in aspiration and pre-dispose to pulmonary complications. We predicted a worse outcome (particularly the development of pneumonia) in patients with CSCIs associated with ND. Spinal cord injury may be divided into both primary and secondary mechanisms of injury. Archives of physical medicine and rehabilitation, 80 (11), 1391-1396. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury: results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial—National Acute Spinal Cord Injury Study. Acute Patient Rehabilitation for Spinal Cord Injury. Spinal Cord 2014; 53: 150-154. (1996). Spinal cord injury impacts an individual’s physical, psychological, and social well-being and places substantial financial burden on health care systems worldwide. Central cord syndrome: Impacting the center of the spinal cord, this injury damages nerves that relay signals to the spinal cord from the brain. The aim of this trial is to determine the effect on all-cause mortality of a sustainable model of community-based care provided over the first 2 years after discharge. Talbott JF, Whetstone WD, Readdy WJ, Ferguson AR, Bresnahan JC, Saigal R, Hawryluk GW, Beattie MS, Mabray MC, Pan JZ, Manley GT, Dhall SS. AU - Krause, J. Incidence, aetiology and the demographics of the spinal In the United States, there are over 200,000 men with spinal cord injuries (SCIs) who are at risk for lower limb fractures. Rajah’s lawyer discusses with him that estate planning, potential legal action, and determination of future care costs will take into account the patient’s estimated life expectancy. Spinal cord injury has become epidemic in modern society. Included is a statistical snapshot of SCI today that answers questions such as, Who are most affected by a spinal cord injury—men or women? #1. This study analyzed the mortality in 1453 spinal cord injured patients admitted early after injury to a specialised Spinal Injuries Unit within a University teaching hospital over a 40-year period. Paresis or paralysis of the respiratory muscles can lead to respiratory insufficiency, which is dependent on the level and completeness of the injury. Traumatic spinal cord injury in Botswana: characteristics, aetiology, and mortality. Weeks and months may elapse before the patient is anywhere near their former self; progress to the best possible recovery may take years. Initially patients with spinal cord injury will present with atonia and arreflexia below the level of the lesion (spinal shock) and within a few days or weeks will experience spasticity and hyperreflexia. Approximately 77. III. Kemp & Krause (1999) state that there has been a 2000% increase in life expectancy following spinal cord injury in the past 50 years compared with a 30% increase for the non-disabled population. Rajah’s life expectancy is lower than another man of his age, because of the spinal cord injury. Keep on your feet. Acute spinal cord injury is a devastating condition typically affecting young people, mostly males. Objectives: To review the epidemiological indicators of SCI, such as incidence, prevalence, demographic characteristics, etiology, level and severity of injury, complications and mortality. Object. living with a spinal cord injury, but because it is estimation, this number could be higher or lower. AU - Pickelsimer, E. The College of Surgeons of East, Central and Southern Africa (COSECSA) is an independent body that fosters postgraduate education in surgery and provides surgical training throughout East, Central and Southern Africa. To investigate the causes of death in patients who were ≤50 years at the time of traumatic spinal cord injury (tSCI). T1 - Acute spinal cord injury. The impact of specialized centers of care for spinal cord injury on length of stay, complications, and mortality: a systematic review of the literature. Löfvenmark I, Hasselberg M, Nilsson Wikmar L, Hultling C, Norrbrink C. T2 - Relationship with social support, education, and income. A large number of neurostimulator devices, some used for spinal cord stimulation (SCS), have been approved by FDA through premarket approval process. T2 - Risk factors for mortality. We sought to determine the optimum timing of A spinal cord injury (SCI) is damage to the spinal cord that results in a loss of function, such as mobility and/or feeling. 5 increased risk, and C6 to C8 a 1. Acute Clinical Guidelines in Spinal Cord Injury tend to focus more on the Medical Management covering interventions when the diagnosis is made, medical stability is achieved and early complications prevented, but in some instances extends into the rehabilitation phase when an individual has ongoing needs around their medical managament and stabilisation of spinal cord injury. Frequent causes of spinal cord injuries are trauma (car accident, gunshot, falls, etc. Falls are not an inevitable part of aging. Number of Americans living with a spinal cord injury: There are approximately 259,000 people in the U. Despite advances made in the understanding of the pathogenesis and improvements in early recognition and treatment, it remains a devastating event, often producing severe and permanent disability. Patient mortality was compared with mortality in the Prospective cohort study Identify the association between health behaviors and risk of all-cause and cause-specific mortality in adults with chronic spinal cord injury (SCI) A large rehabilitation Life expectancy estimates are based on the actual long-term survival experiences of persons treated at any current or previously funded model spinal cord injury care system or any of the three Shriners Hospital spinal cord injury units (Philadelphia, Chicago and Sacramento) with follow-up through January 2018. Objective:Nontraumatic spinal cord injuries (NTSCIs) form a heterogeneous group of diseases, which may evolve into a life-threatening condition. AU - Levi, Allan D. According to the National Spinal Cord Injury Association, as many as 450,000 people in the U. Hence, Spinal cord injury (SCI) is an insult to the spinal cord resulting in a change, either temporary or permanent, in its normal motor, sensory, or autonomic function. T1 - Bacteremia in the chronic spinal cord injury population. This will be a prospective registry conducted and maintained at Mayo Clinic Rochester from which collaborating sites within Mayo, Mayo Health Systems, and other spinal cord injury centers can draw from in order to fulfill research enrollment. Almost a third occur in the thoracic area Recovery from a traumatic brain injury is a long, difficult process. T1 - Risk of mortality after spinal cord injury. 20 Sep 2012 describe the mortality profile of patients with spinal injuries brought to a level I trauma centre characteristics of the traumatic spinal cord injury. • Mortality elevated compared to population norms (SMR of 2. Method: 158 randomly selected death records of persons with SCI from the years 1979 to 1999, were analysed retrospectively in August 2009, at the Centre for the Rehabilitation of the Paralysed, (CRP), Savar, Dhaka, Bangladesh. Conclusion: The presence of either proteinuria with protein of 500 mg/d or greater or CrCl less than 60 mL/min is associated independently with increased mortality in the chronic spinal cord injury population. We were very fortunate to have the chairman of the initial guideline, Susan L. Setting: Two spinal cord injury (SCI) in terms of planning necessary provisions for. In consideration of the new evidence and recent discussion concerning spinal immobilization, the National Registry of Emergency Medical Technicians (NREMT) has completed a review of the available published documents to date, including the resources listed below 1-7. Causes of death in people with spinal cord injury The mortality rate was greater than expected from non-injured population mortality rates (37 deaths compared to 25. 2011;28:1363-1370. Spinal cord injury (SCI) is a devastating event resulting in permanent loss of neurological function. The acute man-agement of patients with spinal cord injury can significantly affect the patient’s eventual neu- They analyzed the infection-associated mortality during a period of 10 years following each patient’s spinal cord injury. Epidemiology of worldwide spinal cord injury: a literature review Yi Kang,1,2,* Han Ding,1,2,* Hengxing Zhou,1,2 Zhijian Wei,1,2 Lu Liu,1,2 Dayu Pan,1,2 Shiqing Feng1,2 1Department of Orthopaedics, Tianjin Medical University General Hospital, 2Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Without immediate medical attention, C1 spinal cord injuries are typically fatal. This spinal cord is encased in the protective covering of spinal vertebrae of the spinal column to prevent its damage from shock or injury. The Brain and Spinal Cord Injury Program's purpose is to provide all eligible Florida residents who sustain a traumatic brain or spinal cord injury the opportunity to obtain the necessary services that will enable them to return to an appropriate level of functioning in their community. As of 2010, the number of people living with spinal cord injury reaches more than a quarter of a million in the country. Outcomes after acute traumatic spinal cord injury in Botswana – from admission to discharge. Despite an increasing incidence of spinal cord injury (SCI) in the elderly and evidence that age appears to influence outcome after neurotrauma, surprisingly little is known regarding clinical outc This does not count people who die from a spinal cord injury before reaching the hospital. Spinal cord injury (SCI) is thankfully a relatively rare injury, but one with profound personal and community impacts. Almost half (48%) of the traumatic SCI cases sustained in 2015–16 were due to a fall. 2 In an earlier trial (the National Acute Spinal Cord Injury Study, or NASCIS 1) we compared a BACKGROUND: We aim to assess the long-term trend of and identify risk factors for traumatic spinal cord injury (TSCI) mortality from 1981 through 1998 in the state of South Carolina (SC). Roland Thietje, M. Other organizations conservatively estimate this figure to be about 250,000. Spinal cord injury medicine. Spinal cord injury (SCI) remains a devastating injury for both patients and their families. † Maintenance of mean arterial blood pressure between 85 and 90 mm Hg for the first 7 days following an acute spinal cord injury is Fatalities resulting from catastrophic brain and spinal cord injuries occur infrequently among high school and college football players. Mortality in patients with traumatic spinal cord injury: Descriptive analysis of 62 deceased subjects. Life expectancies for persons with SCI continue to increase, but are still somewhat below life expectancies for those with no spinal cord injury. An understanding of the issues related to chronic spinal cord injury should commence from an appreciation of the events that caused the primary injury. S. Injuries to the nerves and tissue relating to the cervical region are the most severe of all spinal cord injuries because the higher up in the spine an injury occurs, the more damage that is caused to the central nervous system. 10 Parent S, Barchi S, LeBreton, Sasha S, et al. The actual damage of the spinal cord or spinal canal can vary in severity depending on the cause, but it may often cause permanent changes in the individual’s strength and bodily sensations. the Spine to emphasize the importance of SCI and other spinal disorders. of spinal cord injury patients are left tetraplegic (partial or total paralysis of the arms, legs and torso Pooled estimates of standardized mortality ratios in tetraplegics were 2. Spinal Cord Injury (SCI): Scientific Articles. Objectives: To analyse acute and long-term mortality, estimate life expectancy and identify survival patterns of individuals For isolated spinal cord injuries the mortality after one year is about 5-7%. Spinal Cord Injury Mary C. SCI Forum Report & Video Aging with a Spinal Cord Injury. Bauman a ,bc de, Miroslav Radulovic , Marvin Lessera a Rehabilitation Research and Development Center of Excellence for the Medical Consequences of Spinal Cord Injury, The James J. LONG TERM LIFE EXPECTANCY IN SPINAL CORD INJURY (SCI) IMPLICATIONS FOR THE UNDERWRITING OF SUBSTANDARD ANNUITIES LEONARDO CHAIT, MD Clinical Associate Professor of Medicine UCLA Chief Medical Director Executive Life Insurance Company. AU - Todd, Michael. Separate analyses are presented for each of the three categories. Life Expectancy and Cause of Death After Spinal Cord Injury. The SCI patients usually stay in hospital  19 Dec 2017 This 14th report in the Spinal cord injury, Australia series presents national . expectancy, with both the level and severity of lesion Paraplegia 1990; 28: 545 ± 555. ORGANIZATION OF A SPINAL CORD INJURY UNIT CONCLUSION *Assistant Chief, Spinal Cord Injury Service, V. While historically spinal cord injury has been associated with very high mortality rates, the work of the American Neurosurgeon Dr Donald Munro at Boston City  2000; Garshick et al. A number of e†cient and informative methods are Spinal Cord Injury Robert Morgan, MD lengths of stay, but lower mortality. Treatment is directed at relieving compression. (1987) report, the modified mortality table obtained for spinal cord injury is affected most by age at injury, I The relative mortality ratio is defined as the number of persons dying during the Spinal Cord Injury (SCI) Facts and Figures at a Glance 2016 SCI Data Sheet This data sheet is a quick reference on demographics and the use of services by people with spinal cord injury (SCI). 3 The total annual costs of TSCI in Australia is estimated to be $2 billion The first of these, analyzed extant data from the Spinal Cord Injury Model Systems and a linked study conducted by a subset of funded Model Systems. Males accounted for 80% of traumatic SCI cases. 47-2. Background: . Summary. Elisabeth The Stem Cell Therapy for Spinal Cord Injury helps due to the unlimited divisions and strong power to differentiate into all the cells of different lineage, the power of stem cells has been harnessed by our technology to isolate them outside the human body, concentrate in a clean environment, and implant back. Patients with chronic spinal cord dysfunction often require anesthesia for urologic, orthopedic, and plastic surgical procedures. mortality among persons with spinal cord injury: accelerated ageing process. Hypotension may be The study has con®rmed our earlier impression that 18 DeVivo MJ, Kartus PL, Stover SL, Fine PR. traumatic spinal cord injury (TSCI), 1952e2001. “spinal cord injury” and “neurological deficit. S, Hasselberg M. Life Expectancy after Spinal Cord Injury Wise Young PhD MD 1 June 2012 A friend with spinal cord injury asked me recently what his life expectancy is. Rehabilitation phase after acute spinal cord injury. Back in the 1940s, the life expectancy for a person with a spinal cord injury was an average of just over a year. Abstract. Spinal Cord/Brain Injury and the Neurogenic Bladder Seong Jin Jeong, MDa, Sung Yong Cho, MDb, Seung-June Oh, MDb,* The mortality of patients with neurogenic bladder (NB) secondary to major neurologic abnormalities (1 percent) in the registry that had both head and spinal cord injuries together. The Brain and Spinal Cord Injury Program (BSCIP) is administered by the Florida Department of Health. They can cause mortality and morbidity. While the worldwide incidence of traumatic spinal cord injury (TSCI) is low, its effects on individuals can be debilitating and life‐threatening. Study investigated the association of multiple sets of risk and protective factors (biographic and injury, socioeconomic, health) with cause-specific mortality after spinal cord injury (SCI). Diabetic animals show a higher mortality after SCI. ) or disease (polio, spina bifida, Friedreich’s ataxia, etc. Spungen c e, William A. In the United States, there are over 200,000 men with spinal cord injuries between incident lower extremity fracture and increased mortality (hazard ratio [ HR],  In the Balkan Wars (1912–13), there was a 95 percent mortality rate for patients with spinal cord injury, and in World War I (1914–18), about 80 percent of  3 May 2018 Cervical spine fractures with or without spinal cord injury (SCI) Acute in- hospital mortality was determined from hospital records and  20 Dec 2017 Infectious diseases after spinal cord injury (SCI) are important. Traumatic injury to the vascular supply of the spinal cord results in cord ischemia. The higher the injury, the greater the loss of function. Various lesions can compress the spinal cord, causing segmental sensory, motor, reflex, and sphincter deficits. The mission of The Spinal Cord Injury Zone is to archive important Spinal Cord Injury News and Spinal Cord Injury Information for education and awareness. The personal disability is typically substantial, with significant reductions in community participation, employment and quality of life (QOL) [1–3]. Ellen Merete Hagen. Massery, M. As progress allows, the patient is moved to acute rehabilitation. Mortality rates are significantly higher during the first year after injury than during subsequent years, particularly for severely injured persons. The pri-mary injury, in large part, determines a given patient’s neurologic grade on admission and thereby is the strongest prognostic indicator. The date of death was obtained from the National Population Register, and causes of death recorded by linkage to the Norwegian Cause of Death Registry. 2–7 These epidemiologic studies are important to determine specific survival estimates within subgroups, assess the societal economic burden The association between the etiology of a spinal cord injury and time to mortality in the United States: A 44-year investigation Ryan McGrath Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, North Dakota, USA; Department of Physical Medicine and Rehabilitation, Medical School, University of Michigan Study design: A literature review of worldwide epidemiology of spinal cord injury (SCI). Retrospective study. ). JAMA 1997;277(20):1597–1604. 22(2):186-92. Peters VA Medical Center, Bronx, NY, United States Background: We aim to assess the long-term trend of and identify risk factors for traumatic spinal cord injury (TSCI) mortality from 1981 through 1998 in the state of South Carolina (SC). We sought to characterize spectrum, causes of admission and predictors of death in patients with NTSCI treated at the neurological intensive care unit (NICU). It is emotionally draining for both the patient and the patient’s family. mortality of spinal cord injury

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