Cause, risk factors and prevention

Traumatic spinal cord injuries (SCIs) from falls and road traffic accidents are the leading cause of SCI, followed by violence (including self-harm and attempted suicide) and work or sports-related injuries. Emergencies can also result in surges in SCI. Earthquakes, for example, can cause increases in SCI due to blunt trauma; conflicts may cause surges in penetrating injuries. Non-traumatic SCIs are also increasing, specifically in ageing populations, given increases in non-communicable diseases such as tumors, degenerative and vascular conditions that can cause spinal cord damage.

Effective interventions are available to prevent many causes of traumatic SCI. These include improvements in road infrastructure, vehicles and people’s road behaviors to avoid road traffic accidents, window guards to prevent falls, policies to thwart the harmful use of alcohol and access to firearms to reduce violence, and domestic violence and suicide prevention strategies (including equitable mental health services). Prevention of non-traumatic SCI includes early diagnosis and treatment of the underlying health condition.

The prevention, early diagnosis and treatment of SCI related secondary conditions are essential to increase life expectancy.

Treatment, rehabilitation and management

Timely access to prehospital management, emergency and acute care and rehabilitation is essential to ensure survival and restore optimal levels of functioning, aimed at minimizing long-term disability. Long-term management is indispensable to maintain functioning and to prevent secondary conditions and premature mortality. Essential measures include the following:

• timely, appropriate pre-hospital management: quick recognition of suspected SCI, rapid evaluation and initiation of injury management, including spine immobilization, as needed;
• acute care (including surgical intervention) appropriate to injury type and severity, degree of instability, presence of neural compression, and in accordance with the person’s and their family’s wishes;
• access to acute, post-acute and ongoing multidisciplinary rehabilitation including mental health services to address the existing impairments and optimize functioning, independence, community integration including vocational reintegration, and overall well-being;
• access to assistive products that enable people to perform everyday activities they otherwise couldn’t are essential to increase functioning and independency;
• access to ongoing health care to detect and manage complications and reduce risks of secondary conditions; and

• specialized knowledge on SCI and skills among medical care and rehabilitation providers.

Persons with disabilities such as SCI continue to experience substantial health inequities. According to the Convention on the Rights of Persons with Disabilities, Member States must ensure that persons with SCI can access the same range, quality and standard of free or affordable health care and social support as others. Addressing inequities is essential to realize this mandate.

Self-care

Appropriate self-management is indispensable to manage SCI related impairments, restore optimal levels of functioning and prevent secondary conditions. Self-management requires competencies to apply effective self-care strategies as independently as possible and implement a healthy lifestyle.

However, people with more severe SCI often require ongoing care and support provided largely by informal carers. Challenges for carers include stress, role strain, financial burden, social isolation, lack of community services and bereavement in the event of loss of loved ones. Caring for a person with SCI may affect the carer’s own health, well-being and social relationships. Effective carer support and self-care interventions for health can significantly alleviate carer strain and enhance quality of care and participation of people with SCI.

Self-care interventions provided by health workers aim to empower people with SCI and their families to care for their health, prevent secondary conditions, maintain optimal levels of functioning, and foster coping strategies.