A study from the 2008 American Spinal Injury Association (ASIA) meeting reported that, on the basis of the prevalence of 250,000 individuals with spinal cord injury alive in the United States today, the aggregate cost for managing patients who have a spinal cord injury is $22.16 billion per year.

Bridewell et al reported on "What's new in Spinal Cord Injury" in a recent issue of the Journal of Bone & Joint Surgery. (J Bone Joint Surg Am. 2009;91:1822-1834. doi:10.2106/JBJS.I.00488)

Managing patients who have a spinal cord injury is a major social issue, particularly in the setting of a national fiscal healthcare crisis. As this population continues to increase, it is imperative that strides are made in the management and evaluation of these patients.

This past year was particularly exciting for surgeons and scientists in the field of spinal cord injury. Emphasis was placed on the evaluation of functional outcomes and prognostic indicators of mortality following spinal cord injury. The first stem-cell trial for spinal cord injury was initiated, and preliminary results evaluating the role of early surgical decompression following spinal cord injury were reported.

Outcome Measures
The 2006 National Institute on Disability and Rehabilitation Research (NIDRR) Spinal Cord Injury Measures Meeting continued to generate reports in The Journal of Spinal Cord
Medicine. Reports from 2008 focused on the evaluation of outcome measures and measures of functional recovery. One study provided guidelines for the evaluation of outcome
measures for spinal cord injury, emphasizing the methods and principles important in a systematic review.

This study was based on the notion that, despite the fact that many outcome measures are described as ‘‘reliable and valid,’’ there are no specifications of how reliable or how valid they are or in what set of patients they can be used. The authors devised a 5-point method of grading measures of health, function, and quality of life and applied it to spinal cord injury outcome measures.

Another study from the Measures meeting focused on the evaluation of functional status following spinal cord injury as neurologic recovery does not always translate into functional recovery. A multinational work group analyzed four functional outcome scoring methods and concluded that the latest version of the Spinal Cord Independence Measure (SCIM III) should be the primary functional recovery outcome measure for spinal cord injury.

Proceedings from the 2008 ASIA meeting focused on mortality following spinal cord injury. One study evaluated the risk of mortality in adults and found that subsequent injuries,
amputations, fractures, and depressive symptoms should become the focus of prevention efforts. These conditions serve as indicators of a high risk of mortality and the need for immediate intervention.

Another study evaluated whether age at the time of the injury and comorbidity indices are predictors of inhospital mortality and length of stay in a spinal cord injurycare facility. Clinical outcomes and mortality were significantly associated with age, the Charlson Comorbidity Index (CCI), the number of ICD-9 codes, and the Cumulative Illness Rating
Scale. Length of stay in the acute spinal cord injury facility was only directly correlated with the CCI. The same group of investigators also reported on mortality and neurologic outcomes in the geriatric population following spinal cord injury.

They found that elderly individuals had significantly greater mortality rates at all time points following spinal cord injury when compared with younger patients. However, among survivors, age was not correlated with motor or sensory recovery or pain scores. This finding provides a rationale for individualizing treatment approaches for elderly patients with spinal cord injury as the opportunity exists for neurologic recovery inthis patient subgroup.