Spinal Cord Injury

The research literature shows clearly that life expectancy in SCI is significantly reduced from normal. The magnitude of the reduction depends on level and grade. As would be expected, life expectancy is less if the injury is complete and/or the neurological level is higher.

For some examples, see Table 4 from Strauss et al. 2007,5 which is reproduced below. It applies to a 25 year-old male. As may be seen, in the most severe case (complete injury at levels C1 – C3), the life expectancy is 50% of normal. For grade D injuries (“minimal neurological deficit”), the estimate is 88% of normal. For females, or for persons older than 25, the percentage of normal life expectancy is similar, to a rough approximation, though the percentage tends to be somewhat smaller at older ages.

Ventilator-dependence. The research data shows that the great majority of persons who are permanently ventilator-dependent after SCI have complete injuries at the high or mid-cervical levels. As would be expected, such persons are subject to higher rates of morbidity and mortality, and life expectancy is therefore lower than for persons with injuries of the same grade and level who are not ventilator-dependent. The most recent research on life expectancy of ventilator-dependent persons4 indicates lower life expectancies than had been reported earlier.7,13

Persons whose SCI occurred in childhood have lower life expectancies than those injured in adulthood, other factors being equal.3

Secular trends in life expectancy after SCI. It seems to be widely believed that life expectancy after SCI has improved dramatically in recent decades. A careful reading of the research literature5,7,9 shows, however, that the pattern is more complex than this. There has been a major improvement in survival during the critical first few years after the injury, mortality rates having fallen by some 50% in recent decades. For the subsequent period, however, there has been little if any improvements in survival.

Smoking and SCI. The research literature indicates that smoking is especially deleterious for persons with SCI.

The same appears to be true of persons with SCI who are morbidly obese.

It has been suggested that economic factors play a major role in life expectancy of persons with SCI (Krause et al.14). More recent work,1 however, indicates that this is not the case, except that persons with SCI in the most unfavorable economic category fare significantly worse than the others.


References

  1. Strauss D, DeVivo M, Shavelle R, Brooks J, Paculdo D (2008). Economic factors and longevity in spinal cord injury: A reappraisal. Archives of Physical Medicine and Rehabilitation, 89:572-574.
  2. DeVivo MJ (2007). Trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973-2006. Spinal Cord, 45:713-721.
  3. Shavelle RM, DeVivo MJ, Paculdo DR, Vogel LC, Strauss DJ (2007). Long-term survival after childhood spinal cord injury. Journal of Spinal Cord Medicine, 30:S48-S54.
  4. Shavelle RM, DeVivo MJ, Strauss DJ, Paculdo DR, Lammertse DP, Day SM (2006). Long-term survival of persons ventilator dependent after spinal cord injury. Journal of Spinal Cord Medicine, 29:511-519.
  5. Strauss DJ, DeVivo MJ, Paculdo DR, Shavelle RM (2006). Trends in life expectancy after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 87:1079-1085.
  6. Strauss DJ, DeVivo M, Shavelle RM (2000). Long-term mortality risk after spinal cord injury. Journal of Insurance Medicine, 32:11-16.
  7. DeVivo MJ, Krause JS, Lammertse DP (1999). Recent trends in mortality and causes of death among persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 80:1411-1419.
  8. Coll JR, Frankel HL, Charlifue SW, Whiteneck GG (1998). Evaluating neurological group homogeneity in assessing the mortality risk for people with spinal cord injuries. Spinal Cord, 36:275-279.
  9. Frankel HL et al. (1998). Long-term survival in spinal cord injury: A fifty year investigation. Spinal Cord, 36: 266-274.
  10. Yeo JD, Walsh J, Rutkowski S, Soden R, Craven M, Middleton J (1998). Mortality following spinal cord injury. Spinal Cord, 36:329-336.
  11. McColl MA, Walker J, Stirling P, Wilkins R, Corey P (1997). Expectations of life and health among spinal cord injured patients. Spinal Cord, 35:818-828.
  12. DeVivo MJ, Stover SL (1995). Long-term survival and causes of death. In: SL Stover, JA DeLisa, GG Whiteneck (Eds.), Spinal cord injury, pp.289-316. Gaithersburg, MD: Aspen.
  13. DeVivo MJ, Ivie SC (1995). Life expectancy of ventilator-dependent persons with spinal cord injuries. Chest, 108:226-232.
  14. Krause JS, DeVivo MJ, Jackson AB (2004). Health status, community integration, and economic risk factors for mortality after spinal cord injury. Archives of Physical Medicine & Rehabilitation, 85:1764-1773.

[The studies referenced above are available on the articles page.]