Introductory Chapter. Spinal Cord Injury

The annual global incidence of traumatic spinal cord injury (SCI) was estimated by the Global Burden of Disease Study in 2016, and it resulted in as high as 0.93 million (0.78–1.16 million) per year, with an age-standardized incidence rate of 13 (11–16) per 100,000 population [1]. In the USA, the principal causes of SCI are represented by motor vehicle accidents (36–48%), violence (5–29%), falls (17–21%), and recreational activities (7–16%) [2]. The socioeconomic burden is extremely high due to the young age, the severity of acquired disabilities, and both direct and indirect health-related costs. In fact, the annual national cost in 2009 was as high as $1,7 billion [3], and for each patient ranged from $30,770 to $62,563 in 2016 [4]. The most significant cost derived from the severity of disability and complications developed during the hospitalization such as pressure ulcers and infections [5]. The SCI burden is extended also to the psychology of the younger patients, suddenly experiencing paraplegia or quadriplegia [6, 7]. It has been reported that people suffering from SCI are 2–5 times more likely to die prematurely compared to the healthy population [8, 9]. In SCI, the timing for intervention is crucial. Several studies have shown that early medical-surgical intervention could effectively improve functional outcomes. According to the Advanced Traumatic Life Support (ATLS) guidelines, any obstruction of upper airways should be restored while paying attention to neck and spine mobilization. The immobilization procedures should be fastidiously observed even in penetrating trauma without interfering with resuscitation efforts [10]. After immobilization, the patient should be quickly transferred to the closest trauma center hospital.