Original ArticleTraumatic Spinal Injury: Global Epidemiology and Worldwide Volume
Introduction
Traumatic spinal injury (TSI) includes a multitude of injuries to the spinal cord, nerve roots, osseous structures, and discoligamentous components of the spinal column.1 Injuries may be secondary to blunt or penetrating trauma and result from both high-energy and low-energy mechanisms.2, 3 Damage to the spinal column can lead to mechanical instability, pain, and impaired mobility, and damage to neurologic structures commonly results in partial or complete paralysis.1, 4, 5 Spinal cord injury (SCI) holds a more limited definition and specifically pertains to injuries sustained to the spinal cord leading to neurologic deficits often measured using a clinical score such as the ASIA (American Spinal Injury Association) score.6 Regardless of injury type, TSI has the potential to cause severe disability or death.
Little is known regarding the worldwide volume of TSI. The incidence of a particular subset of TSI, traumatic SCI, is better understood. Estimated SCI incidences range from 8 to 246 cases per million people per year.7, 8, 9 Although this is important information, the incidence of SCI represents only a fraction of the worldwide burden of TSI. The magnitude of effect of TSI as a global health issue remains obscure.
The dearth of available data, especially from low- and middle-income countries (LMICs), remains an obstacle to the assessment of the global burden of TSI. This lack of knowledge stands as a major impediment to the development of national and international agendas focused on injury prevention, training of a capable medical workforce, and the creation of effective medical care delivery systems. The size of the neurosurgical workforce, responsible in large part for the care of TSI, is woefully inadequate in many parts of the world.10 Often, as is the irony with many public health problems, the resources to treat disease and injury are limited where they are needed most. Yet, in the case of TSI, even the most basic epidemiologic information is absent, precluding targeted resource allocation. In this study, we performed a systematic review and meta-analysis of the TSI literature to estimate the global volume of this heterogeneous group of injuries.
Section snippets
Systematic Review
A systematic review was conducted according to the guidelines set forth by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement.11 This review consisted of a comprehensive search of literature published between January 1, 2000 and October 17, 2016 querying PubMed, Embase, and the Cochrane Database of Systematic Reviews. A full list of search terms can be found in Appendix 1,Section A.
Two authors (R.K. and J.L.) jointly reviewed all titles, abstracts, and
Literature Yield
The initial literature search yielded 5733 articles, of which 5493 were from PubMed, 233 from Embase, and 7 from Cochrane Database of Systematic Reviews. After 5277 titles were excluded, 456 abstracts remained, of which 165 were selected for full article review (Figure 1). Bibliography review of the selected articles was then performed and yielded 14 additional abstracts for review, none of which was included in the final selection. Thus, 102 articles were included in the final selection (
Discussion
To the best of our knowledge, this report represents the first attempt to define the volume of TSI worldwide. It encompassed 102 studies from 32 different countries spread out among all the WHO regions. Furthermore, studies from every income stratification of the World Bank Country and Lending Groups Classification system were included in this review.
Neurologic trauma remains a significant cause of death and disability worldwide.115, 116 These injuries often have preventable causes such as
Conclusions
TSI is a major source of morbidity and mortality throughout the world. It is estimated that 768,473–790,695 people have a TSI each year. The proportion of patients with TSI with SCI is higher in LMICs compared with HICs. Partly preventable mechanisms, including road traffic accidents and falls, are the main causes of TSI globally. Further investigation is needed to delineate local and regional incidences and causes of TSI throughout the world, especially in LMICs. Public health initiatives
Acknowledgments
We acknowledge the Vanderbilt Medical Scholars Program for providing Abbas Rattani with support on this project.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.