Spinal cord trauma

This chapter discusses the clinical and radiologic examination and findings for patients with known or suspected acute spinal cord trauma. It does not cover injury to other structures of the spine, including the discs, ligaments, and vertebrae, except as these relate to acute spinal cord trauma. The average estimated incidence of traumatic spinal cord injury (SCI) in the United States is 40 per million, which is higher than in the rest of the world [1]. In Western Europe, the median incidence of traumatic SCI is 16 per million, with reports ranging from 9.2 per million in Denmark to 33.6 per million in Greece [2]. In the United States, motor-vehicle crashes (MVCs) are the most common cause of SCI overall although, in people over 60, falls are the most common cause. In developed countries, the proportion of traumatic SCI due to MVCs tends to be stable or decreasing, likely due to safer cars and better infrastructure. In developing countries, the proportion of SCI caused by MVCs is increasing, likely because motor-vehicle use is increasing without standardized vehicle safety equipment or infrastructure. Injuries from falls in the elderly are also increasing in developed countries as the proportion of the population surviving to old age increases. In addition, SCI due to violence is more common in South Africa, the Middle East, Brazil, and the USA than in the rest of the world [2]. The mechanism and level of SCI also vary by age and gender. Rates are lowest in young children and highest in persons in their late teens or early twenties, with a possible secondary peak among the elderly [1]. SCI is three to four times more common in males than in females. In children younger than 8 years of age, SCI is more commonly due to MVCs, more commonly involves the upper cervical spine, and more commonly involves injury to the ligaments or spinal cord without necessarily involving the bones. In contrast, in children older than 8 years of age, SCI is most commonly sports-related, peaking at 13–15 years of age, is more common in males, and more often involves the lower cervical spine [3].