Spinal cord injury (SCI)

Refers to any injury to the spinal cord that is caused by trauma instead of disease.

Total health care costs related to TSCIs exceed $10 billion annually in the United States alone, and lifetime per person direct and indirect costs can exceed $3 million ^{1) 2)}.

There is disagreement over what should be defined as “the level” of a spinal cord injury. Some define the “level” of a spinal cord injury as the lowest level of completely normal function (thus a patient would be termed a C5 quadriplegic even with minor C6 motor function). However, most sources define the “level” as the most caudal segment with a motor function that is at least 3 out of 5 and if pain and temperature sensation is present.

Spinal cord injury epidemiology.

see Spinal cord injury classification.

Spinal cord injuries have many causes, but are typically associated with major trauma from motor vehicle accidents, falls, sports injuries, and violence.

see Spinal stab wound.

Multiple cellular, molecular, and biochemical changes contribute to the etiology and treatment outcome of contusion spinal cord injury (SCI). MicroRNAs (MicroRNAs) aberrant expression have been found after SCI ³⁾.

see Spinal cord injury pathophysiology

Although many scholars have utilized high-throughput microarrays to delineate gene expression patterns after spinal cord injury (SCI), no study has evaluated gene changes in nucleus raphe magnus (RM) and somatomotor cortex (SMTC), two areas in brain primarily affected by SCI. In present study, we aimed to analyze the differentially expressed genes (DEGs) of RM and SMTC between SCI model and sham injured control at 4, 24 h, 7, 14, 28 days, and 3 months using microarray dataset GSE2270 downloaded from gene expression omnibus and unpaired significance analysis of microarray method. Protein-protein interaction (PPI) network was constructed for DEGs at crucial time points and significant biological functions were enriched using DAVID. The results indicated that more DEGs were identified at 14 days in RM and at 4 h/3 months in SMTC after SCI. In the PPI network for DEGs at 14 days in RM, interleukin 6, glyceraldehyde-3-phosphate dehydrogenase (GAPDH), FBJ murine osteosarcoma viral oncogene homolog (FOS), tumor necrosis factor, and nuclear receptor subfamily 3, group C, member 1 (glucocorticoid receptor) were the top 5 hub genes; In the PPI network for DEGs at 3 months in SMTC, the top 5 hub genes were ubiquitin B, Ras-related C3 botulinum toxin substrate 1 (rho family, small GTP binding protein Rac1), FOS, Janus kinase 2 and vascular endothelial growth factor A. Hedgehog and Wnt signaling pathways were the top 2 significant pathways in RM. These hub DEGs and pathways may be underlying therapeutic targets for SCI ⁴⁾.

Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence.

Spinal cord injury (SCI) disrupts autonomic circuits and impairs the synchronistic functioning of the autonomic nervous system, leading to inadequate cardiovascular regulation. Individuals with SCI, particularly at or above the sixth thoracic vertebral level (T6), often have impaired regulation of sympathetic vasoconstriction of the peripheral vasculature and the splanchnic circulation and diminished control of heart rate and cardiac output. In addition, impaired descending sympathetic control results in changes in circulating levels of plasma catecholamines, which can have a profound effect on cardiovascular function. Although individuals with lesions below T6 often have normal resting blood pressures, there is evidence of increases in resting heart rate and inadequate cardiovascular response to autonomic provocations such as the head-up tilt and cold face tests ⁵⁾.

ASIA impairment scale

Evaluation of reflexes

Abdominal reflexes…..

see Spinal cord injury diagnosis.

see Spinal cord injury treatment.

Urinary incontinence (UI) rate is high among SCI patients, and more common in females with fairly good proportion of patients using incontinence medication. Main bladder management method was clean intermittent catheterization (CIC) and more prevalent in males, although the use of CIC decreased with time. Urinary stone surgery was the leading surgical procedure ⁶⁾.

Spinal cord injury (SCI) rehabilitation remains a major clinical challenge, especially in cases involving chronic, complete injury. Existing interventions for assisting patients with SCI in walking, including body weight support systems, robotic assistance, and functional electrostimulation of the legs, have not shown evidence of generating significant clinical improvement in somatosensory function below the level of the injury. In the past 2 decades, brain machine interfaces (BMIs) have become popular tools for restoring limb function in paralyzed patients, although no study has suggested that long-term training with BMI-based paradigms and physical training could trigger neurological recovery, particularly in patients with complete SCI

Spinal cord injury outcome

Spinal cord injury complications.

In a Retrospective Observational Cohort Study Ikwuegbuenyi et al. From Muhimbili Orthopaedic Institute, Dar es Salaam; Weill Cornell Medicine, New York publisher in the journal BMJ Open to identify demographic, injury-related, and healthcare system factors associated with clinic follow-up adherence after traumatic spinal injury (TSI) in Tanzania. Fewer than 13% of patients remained in follow-up at 12 months post-TSI. Key predictors of clinic return included private insurance, injury mechanism, shorter hospital stay, neurological improvement, and female sex. The authors call for targeted strategies to enhance long-term follow-up in LMICs.

The study attempts to quantify and elucidate predictors of follow-up adherence among patients with traumatic spinal injuries in a low-resource setting. While the topic is relevant, particularly given global disparities in neurosurgical care, the analysis remains superficial. The selection of variables lacks depth—omitting psychological, transportation, or caregiver support factors. The authors rely heavily on retrospective registry data, yet provide minimal discussion of data quality or loss to follow-up bias beyond basic exclusions.

There is also insufficient interrogation of systemic barriers endemic to Tanzanian healthcare—such as infrastructure deficits or cultural mistrust of allopathic medicine—that could more meaningfully contextualize the findings. The regression analysis is underutilized; while odds ratios are presented, there’s no effort to model interaction effects or assess multicollinearity. Additionally, the use of ASIA Impairment Scale categories in logistic regression, without discussion of baseline functional capacity or socioeconomic stratification, undermines interpretability.

The tone is utilitarian and dry, bordering on inert. The paper reads like a minimally annotated statistical report rather than a critical exploration. Structurally, the abstract frontloads methods but compresses conclusions, failing to reflect the significance of key results. The body of the manuscript (not shown) likely suffers from similar flattening, based on this presentation.

For practicing neurosurgeons—especially those in LMICs—the clinical utility is limited. It’s unclear how this data informs discharge planning, triage, or targeted intervention. There’s no discussion of actionable mechanisms to improve follow-up, such as mobile health (mHealth) platforms or community health worker models. Additionally, the demographic skew (86% male) is acknowledged but unexplored, missing an opportunity to question why women have better follow-up despite being a minority of the cohort.

This study raises a crucial problem—poor longitudinal care after spinal trauma—but fails to deliver an insightful or impactful analysis. It identifies correlates, not causes, and provides no meaningful roadmap forward. The absence of a more layered discussion renders it of limited value beyond bureaucratic benchmarking.

• Takeaway for Neurosurgeons: Insurance status and neurologic improvement predict clinic adherence after spinal trauma, but structural solutions remain absent.
• Bottom Line: A shallow statistical treatment of a deep healthcare inequity; lacks the critical insight or practical relevance needed by frontline neurosurgeons.
• Rating: 4/10

• Article Title: What drives clinic follow-up after traumatic spinal injury? An observational cohort study from Tanzania
• Citation: Ikwuegbuenyi CA, et al. BMJ Open. 2025 Jun 25;15(6):e101267. doi:10.1136/bmjopen-2025-101267.
• Corresponding Author Email: scott.zuckerman@vumc.org