Epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China:a hospital-based retrospective study

Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.

X-irradiation for inhibiting glial scar formation in injured spinal cord

X-irradiation has a beneficial effect in treating spinal cord injury. We supposed that X-irradiation could improve the microenvironment at the site of a spinal cord injury and inhibit glial scar formation. Thus, this study was designed to observe the effects of 8 Gy X-irradiation on the injury site at 6 hours and 2, 4, 7, and 14 days post injury, in terms of improvement in the microenvironment and hind limb motor function. Immunohistochemistry showed that the expression of macrophage marker ED-1 and the area with glial scar formation were reduced. In addition, the Basso, Beattie and Bresnahan score was higher at 7 days post injury relative to the other time points post injury. Results indicated that X-irradiation at a dose of 8 Gy can inhibit glial scar formation and alleviate the inflammatory reaction, thereby repairing spinal cord injury. X-irradiation at 7 days post spinal cord injury may be the best time window.