The incidence and prevalence of spinal cord injury (SCI) in the geriatric population are increasing. Current estimates suggest that the annual incidence of spinal cord injury (SCI) in the geriatric (≯65 years of age) population is 67.9/million with a prevalence as high as 116.3/million. This results in significant morbidity, mortality, and socioeconomic consequences. This review examines epidemiological factors associated with SCI in the elderly. The most common scenario is a fall, causing a cervical incomplete cord injury, in patients with preexisting degenerative changes. This typically causes a central cord syndrome. Risk factors are biological, behavioral, environmental, and socioeconomic. Although there is no significant difference in neurological recovery between older and younger SCI groups, older patients exhibit significantly less functional recovery.

World Health Organization.Active Ageing: A Policy Framework. Geneva: WHO; 2002.
United Nations, Department of Economic and Social Affairs, Population Division World Population Prospects: The 2008 Revision, Highlights. 2009. Working Paper No. ESA/P/ WP.210.
Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey?Spinal Cord. 2006;44(9):523–529.
,
Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey?
,
Spinal Cord.
, vol.
44
(pg.
523
-
529
)
Strauss DJ, Devivo MJ, Paculdo DR, Shavelle RM. Trends in life expectancy after spinal cord injury.Arch Phys Med Rehabil. 2006;87(8):1079–1085.
,
Trends in life expectancy after spinal cord injury
,
Arch Phys Med Rehabil.
, vol.
87
(pg.
1079
-
1085
)
Annual Report for the Model Spinal Cord Injury Care Systems. Birmingham, AL: National Spinal Cord Injury Statistical Center, University of Alabama at Birmingham; December 2007.
,
Annual Report for the Model Spinal Cord Injury Care Systems.
Fassett DR, Harrop JS, Maltenfort M, et al. Mortality rates in geriatric patients with spinal cord injuries.J Neurosurg Spine. 2007;7(3):277– 281.
,
Mortality rates in geriatric patients with spinal cord injuries
,
J Neurosurg Spine.
, vol.
7
Kannus P, Niemi S, Palvanen M, Parkkari J. Continuously increasing number and incidence of fall-induced, fracture-associated, spinal cord injuries in elderly persons.Arch Intern Med. 2000;160(14):2145–2149.
,
Continuously increasing number and incidence of fall-induced, fracture-associated, spinal cord injuries in elderly persons
,
Arch Intern Med.
, vol.
160
(pg.
2145
-
2149
)
Nobunaga AI, Go BK, Karunas RB. Recent demographic and injury trends in people served by the Model Spinal Cord Injury Care Systems.Arch Phys Med Rehabil. 1999;80(11):1372–1382.
,
Recent demographic and injury trends in people served by the Model Spinal Cord Injury Care Systems
,
Arch Phys Med Rehabil.
, vol.
80
(pg.
1372
-
1382
)
Chen HY, Chen SS, Chiu WT, et al. A nationwide epidemiological study of spinal cord injury in geriatric patients in Taiwan.Neuroepidemiology. 1997;16(5):241–247.
,
A nationwide epidemiological study of spinal cord injury in geriatric patients in Taiwan
,
Neuroepidemiology.
, vol.
16
(pg.
241
-
247
)
Furlan JC, Bracken MB, Fehlings MG. Is age a key determinant of mortality and neurological outcome after acute traumatic spinal cord injury?Neurobiol Aging. Jun 10 2008. Epub ahead of print. PMID: 18550225.
Kannus P, Palvanen M, Niemi S, Parkkari J. Alarming rise in the number and incidence of fall-induced cervical spine injuries among older adults.J Gerontol A Biol Sci Med Sci. 2007;62(2):180–183.
,
Alarming rise in the number and incidence of fall-induced cervical spine injuries among older adults
,
J Gerontol A Biol Sci Med Sci.
, vol.
62
(pg.
180
-
183
)
Omeis I, Duggal N, Rubano J, et al. Surgical treatment of C2 fractures in the elderly: a multicenter retrospective analysis.J Spinal Disord Tech. 2009;22(2):91–95.
,
Surgical treatment of C2 fractures in the elderly: a multicenter retrospective analysis
,
J Spinal Disord Tech.
, vol.
22
(pg.
91
-
95
)
Hagen EM, Aarli JA, Gronning M. The clinical significance of spinal cord injuries in patients older than 60 years of age.Acta Neurol Scand. 2005;112(1):42–47.
,
The clinical significance of spinal cord injuries in patients older than 60 years of age
,
Acta Neurol Scand.
, vol.
112
(pg.
42
-
47
)
Krassioukov AV, Furlan JC, Fehlings MG. Medical co-morbidities, secondary complications, and mortality in elderly with acute spinal cord injury.J Neurotrauma. 2003;20(4):391–399.
,
Medical co-morbidities, secondary complications, and mortality in elderly with acute spinal cord injury
,
J Neurotrauma.
, vol.
20
(pg.
391
-
399
)
Lomoschitz FM, Blackmore CC, Mirza SK, Mann FA. Cervical spine injuries in patients 65 years old and older: epidemiologic analysis regarding the effects of age and injury mechanism on distribution, type, and stability of injuries.Am J Roentgenol. 2002;178(3):573– 577.
,
Cervical spine injuries in patients 65 years old and older: epidemiologic analysis regarding the effects of age and injury mechanism on distribution, type, and stability of injuries
,
Am J Roentgenol.
, vol.
178
Kiwerski JE. Injuries to the spinal cord in elderly patients.Injury. 1992;23(6):397–400.
,
Injuries to the spinal cord in elderly patients
,
Injury.
, vol.
23
(pg.
397
-
400
)
Canadian Institute for Health Information.National Trauma Registry 2006 Report: Major Injury in Canada, Includes 2004–2005 Data. Ottawa: CIHI; 2007.
McKinley W, Cifu D, Seel R, et al. Age-related outcomes in persons with spinal cord injury: a summary paper.NeuroRehabilitation. 2003;18(1):83–90.
,
Age-related outcomes in persons with spinal cord injury: a summary paper
,
NeuroRehabilitation.
, vol.
18
(pg.
83
-
90
)
New PW, Sundararajan V. Incidence of nontraumatic spinal cord injury in Victoria, Australia: a population-based study and literature review.Spinal Cord. 2008;46(6):406–411.
,
Incidence of nontraumatic spinal cord injury in Victoria, Australia: a population-based study and literature review
,
Spinal Cord.
, vol.
46
(pg.
406
-
411
)
Osterthun R, Post MW, van Asbeck FW. Characteristics, length of stay and functional outcome of patients with spinal cord injury in Dutch and Flemish rehabilitation centres.Spinal Cord. 2009;47(4):339–344.
,
Characteristics, length of stay and functional outcome of patients with spinal cord injury in Dutch and Flemish rehabilitation centres
,
Spinal Cord.
, vol.
47
(pg.
339
-
344
)
New PW, Rawicki HB, Bailey MJ. Nontraumatic spinal cord injury: demographic characteristics and complications.Arch Phys Med Rehabil. 2002;83(7):996–1001.
,
Nontraumatic spinal cord injury: demographic characteristics and complications
,
Arch Phys Med Rehabil.
, vol.
83
(pg.
996
-
1001
)
Sekhon LH, Fehlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury.Spine. 2001;26(24 Suppl): S2–12.
,
Epidemiology, demographics, and pathophysiology of acute spinal cord injury
,
Spine.
, vol.
26
(pg.
S2
-
12
)
Ryan MD, Henderson JJ. The epidemiology of fractures and fracture-dislocations of the cervical spine.Injury. 1992;23(1):38–40.
,
The epidemiology of fractures and fracture-dislocations of the cervical spine
,
Injury.
, vol.
23
(pg.
38
-
40
)
Jabbour P, Fehlings M, Vaccaro AR, Harrop JS. Traumatic spine injuries in the geriatric population.Neurosurg Focus. 2008;25(5):E16.
,
Traumatic spine injuries in the geriatric population
,
Neurosurg Focus.
, vol.
25
Furlan JC, Kattail D, Fehlings M. The impact of co-morbidities on age-related differences in mortality after acute traumatic spinal cord injury.J Neurotrauma. Mar 10 2009. Epub ahead of print.
DeVivo MJ, Kartus PL, Rutt RD, Stover SL, Fine PR. The influence of age at time of spinal cord injury on rehabilitation outcome.Arch Neurol. 1990;47(6):687–691.
,
The influence of age at time of spinal cord injury on rehabilitation outcome
,
Arch Neurol.
, vol.
47
(pg.
687
-
691
)
Furlan JC, Fehlings M. The impact of age on mortality, impairment and disability among adults with acute traumatic spinal cord injury.J Neurotrauma. May 4 2009. Epub ahead of print.
Cifu DX, Huang ME, Kolakowsky-Hayner SA, Seel RT. Age, outcome, and rehabilitation costs after paraplegia caused by traumatic injury of the thoracic spinal cord, conus medullaris, and cauda equina.J Neurotrauma. 1999;16(9):805–815.
,
Age, outcome, and rehabilitation costs after paraplegia caused by traumatic injury of the thoracic spinal cord, conus medullaris, and cauda equina
,
J Neurotrauma.
, vol.
16
(pg.
805
-
815
)
Cifu DX, Seel RT, Kreutzer JS, McKinley WO. A multicenter investigation of age-related differences in lengths of stay, hospitalization charges, and outcomes for a matched tetraplegia sample.Arch Phys Med Rehabil. 1999;80(7):733–740.
,
A multicenter investigation of age-related differences in lengths of stay, hospitalization charges, and outcomes for a matched tetraplegia sample
,
Arch Phys Med Rehabil.
, vol.
80
(pg.
733
-
740
)
Seel RT, Huang ME, Cifu DX, Kolakowsky-Hayner SA, McKinley WO. Age-related differences in length of stays, hospitalization costs, and outcomes for an injury-matched sample of adults with paraplegia.J Spinal Cord Med. 2001;24(4):241–250.
,
Age-related differences in length of stays, hospitalization costs, and outcomes for an injury-matched sample of adults with paraplegia
,
J Spinal Cord Med.
, vol.
24
(pg.
241
-
250
)
Sieber CC. [The elderly patient--who is that?].Internist (Berl). 2007;48(11):1190, 1192–1194.
,
[The elderly patient--who is that?]
,
Internist (Berl).
, vol.
48
(pg.
1192
-
1194
)
Schuurmans H, Steverink N, Lindenberg S, Frieswijk N, Slaets JP. Old or frail: what tells us more?J Gerontol A Biol Sci Med Sci. 2004;59(9):M962–965.
,
Old or frail: what tells us more?
,
J Gerontol A Biol Sci Med Sci.
, vol.
59
(pg.
M962
-
965
)
WHO Global Report on Falls Prevention in Older Age. Geneva: World Health Organization; 2007.
Young WF. Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons.Am Fam Physician.2000;62(5):1064–1070, 1073.
,
Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons
,
Am Fam Physician.
, vol.
62
(pg.
1064
-
1070
)
Schneider RC, Cherry G, Pantek H. The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine.J Neurosurg. 1954;11(6):546–577.
,
The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine
,
J Neurosurg.
, vol.
11
(pg.
546
-
577
)
Parke WW. Correlative anatomy of cervical spondylotic myelopathy.Spine. 1988;13(7): 831–837.
,
Correlative anatomy of cervical spondylotic myelopathy
,
Spine.
, vol.
13
(pg.
831
-
837
)
Chen L, Yang H, Yang T, Xu Y, Bao Z, Tang T. Effectiveness of surgical treatment for traumatic central cord syndrome.J Neurosurg Spine. 2009;10(1):3–8.
,
Effectiveness of surgical treatment for traumatic central cord syndrome
,
J Neurosurg Spine.
, vol.
10
(pg.
3
-
8
)
Aarabi B, Koltz M, Ibrahimi D. Hyperextension cervical spine injuries and traumatic central cord syndrome.Neurosurg Focus. 2008;25(5): E9.
,
Hyperextension cervical spine injuries and traumatic central cord syndrome
,
Neurosurg Focus.
, vol.
25
Jakob W, Wirz M, van Hedel HJ, Dietz V. Difficulty of elderly SCI subjects to translate motor recovery -“body function”- into activity of daily living.J Neurotrauma. Jul 15 2009. Epub ahead of print.
,
Difficulty of elderly SCI subjects to translate motor recovery -“body function”- into activity of daily living
,
J Neurotrauma. Jul 15
Kennedy P, Evans MJ, Berry C, Mullin J. Comparative analysis of goal achievement during rehabilitation for older and younger adults with spinal cord injury.Spinal Cord. 2003;41(1):44–52.
,
Comparative analysis of goal achievement during rehabilitation for older and younger adults with spinal cord injury
,
Spinal Cord.
, vol.
41
(pg.
44
-
52
)
Stucki G, Cieza A, Melvin J. The International Classification of Functioning, Disability and Health (ICF): a unifying model for the conceptual description of the rehabilitation strategy.J Rehabil Med. 2007;39(4):279–285.
,
The International Classification of Functioning, Disability and Health (ICF): a unifying model for the conceptual description of the rehabilitation strategy
,
J Rehabil Med.
, vol.
39
(pg.
279
-
285
)
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