Traumatic spinal cord injury (TSCI) has been linked to an elevated long-term risk of developing neurologic, psychiatric, cardiovascular, and endocrine comorbidities, highlighting the need for long-term multidisciplinary care, including proactive screening and management.

“The journey doesn’t end when patients with traumatic spinal cord injuries leave the hospital or rehab,” Saef Izzy, MD, neurologist with Mass General Brigham (MGB) in Boston, said in a statement. 

“Programs should be implemented to identify patients at risk so that we can better manage their chronic care and address health issues that put patients at higher risk of death,” Izzy added.

The study was published online on November 4 in JAMA Network Open.

Beyond Acute Complications

The acute complications of TSCI have been well characterized, but the long-term systemic consequences remain understudied, especially in those who were previously healthy prior to their injury. 

To investigate, the researchers conducted a retrospective cohort study of 1038 patients with TSCI from MGB and 1711 patients with TSCI from the University of California (UC), matched (3:1) to 8247 uninjured control patients. All were previously healthy and without any of the comorbidities of interest.

For both cohorts, the most common level of injury was cervical, observed in 381 patients (37%) and 673 patients (39%) in MGB and UC, respectively. 

The researchers documented the incidence of neurologic, psychiatric/substance use disorders, cardiovascular and endocrine disorders, and death over a follow-up period of up to 20 years.

They found that TSCI was associated with increased risk for neurologic disease in both the MGB and UC cohorts, including ischemic stroke (hazard ratios [HRs], 2.5 and 1.6, respectively), dementia (HRs, 3.0 and 2.4), and seizures (HRs, 2.9 and 2.7) compared with the uninjured control cohort.

The significant association between TSCI and dementia and chronic seizure disorders is in line with the results of one retrospective study and case reports, the authors noted.

“Our results confirm these associations in a US-based, racially diverse population, strengthening the evidence for an association between TSCI and subsequent epileptogenesis and neurodegenerative diseases,” they wrote. 

Psychiatric conditions that were more prevalent in the TSCI group included depression (HRs, 2.7 in the MGB cohort and 2.2 in the UC cohort); anxiety disorder (HRs, 2.0 and 2.3); schizophrenia or psychosis (HRs, 4.1 and 2.1); sleep disorder (HR, 2.0 in both cohorts); and suicide ideation, intent, or attempt (HRs, 2.2 and 4.5).

The risk for opioid use disorder was also significantly elevated in both cohorts (HRs, 6.7 and 10.1).

Adults with TSCI also had a higher risk for cardiovascular diseases and associated risk factors across both cohorts, including hypertension (HR, 1.6 in both cohorts) and coronary artery disease (HR, 1.8). An elevated risk for hyperlipidemia was observed in the MGB cohort (HR, 1.5) but not in the UC cohort (HR, 1.2). 

TSCI was also associated with a higher risk for endocrine disorders, although some estimates had wider CIs. These included erectile dysfunction (HRs, 1.8 in MGB and 3.0 in UC) and adrenal insufficiency (HRs, 2.5 and 5.6, respectively).

For most disorders, the association of TSCI with chronic conditions was similar across age groups, including patients aged 18-45 years, and different sites of spinal injuries. 

In addition, several post-TSCI chronic conditions were associated with increased risk for death, including depression (odds ratio [OR], 2.9), substance misuse (OR, 4.0), seizures (OR, 6.4), dementia (OR, 4.8), hypertension (OR, 2.0), pituitary dysfunction (OR, 6.5), and adrenal insufficiency (OR, 5.0).

‘An Atlas of Spinal Cord Disease’

The research is “a welcome and relevant addition to the field of spinal cord medicine and research,” Christopher Vadala, MS, and Jan Schwab, MD, PhD, with the Department of Neurology, The Ohio State University, Columbus, Ohio, the authors of a linked commentary, noted.

“This work provides a comprehensive perspective toward ‘an atlas of spinal cord disease’ (multisystem morbidity)” in the US and allows for the development of “novel hypotheses to unmask the underlying drivers of these respective phenotypes and domains of spinal cord disease,” they wrote.

“The findings highlight opportunities to improve long-term SCI care, enhance prevention programs, and inform new research avenues to better understand and treat SCI as a multiorgan paradigm, with the ultimate goal of improving health, quality of life, and survival in this vulnerable population,” they added. 

The study had no commercial funding. The study and commentary authors reported having no relevant disclosures.