As many as 500,000 people suffer a spinal cord injury each year. People with spinal cord injuries are 2 to 5 times more likely to die prematurely, with worse survival rates in low- and middle-income countries. The new WHO report, “International perspectives on spinal cord injuries”, summarizes the best available evidence on the causes, prevention, care and lived experience of people with spinal cord injury.
Males are most at risk of spinal cord injury between the ages of 20-29 years and 70 years and older, while females are most at risk between the ages of 15-19 years and 60 years and older. Studies report male to female ratios of at least 2:1 among adults.
Up to 90% of spinal cord injury cases are due to traumatic causes such as road traffic crashes, falls and violence. Variations exist across regions. For example, road traffic accidents are the main contributor to spinal cord injury in the African Region (nearly 70% of cases) and the Western Pacific Region (55% of cases) and falls the leading cause in the South-East Asia and Eastern Mediterranean Regions (40% of cases). Non-traumatic spinal cord injury results from conditions such as tumours, spina bifida, and tuberculosis. A third of non-traumatic spinal cord injury is linked to tuberculosis in sub-Saharan Africa.
Most people with spinal cord injury experience chronic pain, and an estimated 20-30% show clinically significant signs of depression. People with spinal cord injury also risk developing secondary conditions that can be debilitating and even life-threatening, such as deep vein thrombosis, urinary tract infections, pressure ulcers and respiratory complications.
Spinal cord injury is associated with lower rates of school enrollment and economic participation. Children with spinal cord injury are less likely than their peers to start school, and once enrolled, less likely to advance. Adults with spinal cord injury face similar barriers to socio-economic participation, with a global unemployment rate of more than 60%. Spinal cord injury carries substantial individual and societal costs.
Many of the consequences associated with spinal cord injury do not result from the condition itself, but from inadequate medical care and rehabilitation services, and from barriers in the physical, social and policy environments that exclude people with spinal cord injury from participation in their communities. Full Implementation of the Convention on the Rights of Persons with Disabilities is urgently required to address these gaps and barriers.
“Spinal cord injury is a medically complex and life-disrupting condition,” notes Dr Etienne Krug, Director of the Department of Violence and Injury Prevention and Disability, WHO. “However, spinal cord injury is preventable, survivable, and need not preclude good health and social inclusion.”
Essential measures for improving the survival, health and participation of people with spinal cord injury include:
timely, appropriate pre-hospital management: quick recognition of suspected spinal cord injury, rapid evaluation and initiation of injury management, including immobilization of the spine; acute care appropriate to the level and severity of injury, degree of instability and presence of neural compression; access to ongoing health care, health education and products such as catheters to reduce risk of secondary conditions and improve quality of life; access to skilled rehabilitation and mental health services to maximize functioning, independence, overall well-being and community integration; access to appropriate assistive devices that can enable people to perform everyday activities, reducing functional limitations and dependency; and specialized knowledge and skills among providers of medical care and rehabilitation services.
Essential measures to secure the right to education and economic participation include legislation, policy and programmes that promote:
physically accessible homes, schools, workplaces, hospitals and transportation; inclusive education; elimination of discrimination in employment and educational settings; vocational rehabilitation to optimize the chance of employment; micro-finance and other forms of self-employment benefits to support alternative forms of economic self-sufficiency; access to social support payments that do not act as disincentive to return to work; and correct understanding of spinal cord injury and positive attitudes towards people living with it.
“International perspectives on spinal cord injuries” was developed in association with the International Spinal Cord Society and Swiss Paraplegic Research, and launched on the occasion of the International Day of Persons with Disabilities on 3 December 2013.
Laura Sminkey
WHO Geneva
