The World Health Organization says as many as
500-thousand people suffer spinal cord injuries every year. People with such injuries are much more likely to die prematurely, with the worst survival rates in low and middle income countries.
The World Health Organization has released a new report called International Perspectives on Spinal Cord Injuries. The WHO’s Alana Officer says while such injuries can cause paralysis, the problem is much bigger than that.
“There are a lot more associated health problems, such as difficulty with bowel and bladder function, difficulty with sexual function, associated problems around mental health conditions. So it’s much broader than just experiencing paralysis.”
Officer, Coordinator for Disability and Rehabilitation, said, “There are three main causes: road traffic crashes, falls and violence.”
The causes of spinal cord injuries vary in frequency from region to region.
“For example,” she said, “road traffic crashes are the main contributors of spinal cord injury in Africa and the Western Pacific region. Falls tend to be the leading cause in Southeast Asia and the Middle East. And then we have high rates of violence in certain countries. We have rates in the U.S. We have high rates in South Africa. And then we’ve also got the non-traumatic causes of spinal cord injuries, such as tumors and cancers, tuberculosis and spinabifida.”
Tuberculosis is often thought of as a lung disease. But in sub-Saharan Africa it accounts for about 30-percent of the non-traumatic causes of spinal cord injuries.
Spinabifida is a defect in the vertebrae of the spine. In severe cases it can affect walking and daily activities. Health officials say they don’t know the exact cause of the problem, but say it may be linked to genes and environmental factors.
More men suffer spinal cord injuries than women.
Officer said, “There’s a ratio of about two to one of males to females. Men tend to be more likely to experience spinal cord injury between the ages of about 20 to 29 -- women, or certainly girls much younger, between sort of 15 and 19. So that’s our first peak in young people. And then we get a second peak, interestingly, in older people. And the major driver of that is falls, tumors, cancer, et cetera.”
The main reason why people with spinal cord injuries are more likely to die prematurely is a lack of access to medical services.
“A lot of people with spinal cord injuries, certainly in low and middle income countries, do not get appropriate emergency response care. Mortality rates are very strongly affected by the quality of the health care system. For example, if you’re in a low income country, you are three times more likely of dying in [a] hospital following a spinal cord injury than you would be in a high income country,” she said.
Officer said that many of the causes of spinal cord injury deaths in low income countries are preventable. These include urinary tract infections and pressure sores, also known as bedsores. These are areas of damaged skin resulting from a patient staying in one position too long. These are usually not life-threatening problems in high-income countries.
“People with spinal cord injuries can live pretty much the same amount of time as somebody without a spinal cord injury. There’s a slight difference, but certainly life expectancy has increased considerably in high income countries. And it’s not the case in low income countries,” said Officer.
The WHO recommends immediate action if a spinal cord injury is suspected, including immobilization of the spine. That should be followed by “acute care appropriate to the level and severity of the injury, degree of instability of the spine and compression of nerves. It also recommends “skilled rehabilitation and mental health services.” The WHO says up to 30-percent of people with spinal cord injuries show “clinically significant signs of depression.”
Officer said, “With the appropriate amount of stabilization and care they may not result in long term dysfunction.”
There’s currently no cure for paralysis from spinal cord injuries, but much research on the problem is underway.
Officer said there’s a lot that can be done to prevent such injuries, including building safer roads and vehicles, reducing drinking and driving and wearing seatbelts. Other measures include improving safety in sports, installing window guards to prevent falls, ensuring workplace safety, having early detection and treatment of TB and improving nutrition to reduce spinabifida.
The World Health Organization urges full implementation of the Convention on the Rights of Persons with Disabilities to better address spinal cord injuries.