There is a major opportunity to reduce the disability and suffering associated with SCI, as well as the economic burden. The most obvious means is to prevent a SCI in the first place. Primary prevention of SCI is a worthy goal, one that is being pursued by a number of Canadian organizations. However, given that it is not realistic to avoid all SCI, and recognizing the profound and unique needs generated by this category of injury, it is essential that we continue to develop and implement treatments and services that minimize disability as well as costs.

Here are three areas that have the potential to reduce the human cost and economic burden of SCI.

1. Reduce the incidence and severity of paralysis

As a result of research and advances in health care, we now know that neural damage to the spinal cord is not limited to the initial trauma; swelling, inflammation, restricted blood flow and oxygen deprivation at the injury site can cause additional damage to the spinal cord. Much can be done in the hours and days following a spinal cord injury to minimize additional damage to the spinal cord, thereby maximizing the ultimate physical functioning of the individual, and reducing long-term health care costs. The Rick Hansen Institute is supporting several clinical trials that show very positive results in reducing the severity of injury. The Ontario Neurotrauma Foundation has created a centre of excellence in neurotrauma research and knowledge mobilization that is recognized worldwide. Reducing the severity of paralysis will lead to reduced length of stay in hospital, reduced incidence of secondary complications, reduced readmissions to hospital, and reduced dependence on home care and long-term care services, which will reduce the economic burden of healthcare costs associated with SCI, estimated at about $1.8 billion annually.

2. Increase in the restoration and maintenance of physical function following injury

Rehabilitation in the months following a spinal cord injury plays a major role in maximizing physical function and independence. Success in developing, validating and implementing best practices in acute, rehabilitative, and community health care will result in maximized physical function, greater ability and independence, reduced long-term care costs, and better quality of life for people living with SCI.

3. Reducing the incidence and severity of secondary complications

Following acute care, most individuals with a new spinal cord injury undergo months of intensive rehabilitation, and learn to adapt to their reduced physical functioning, only to face a host of secondary complications which can prove more debilitating than the spinal cord injury itself. These secondary health complications result in substantial human suffering and escalated health care costs. Extrapolation of data from Australia indicates that 16.7% of individuals with SCI are re-admitted to hospital annually for treatment of secondary health complications.

Three secondary health complications have been identified by individuals with SCI as having the greatest negative impact on their health and wellness, requiring substantial health care interventions:

1. Urinary Tract Infections - Urinary tract infections (UTIs), which occur primarily as a result of necessary catheterizations, have been consistently shown to be the most frequent cause of re-hospitalization for individuals with SCI, with between 24% and 54% of re-hospitalizations resulting from UTIs.
2. Pressure Ulcers - Individuals with a SCI are susceptible to developing pressure ulcers, with approximately 40% of individuals developing a pressure ulcer within any three year period. The consequences of chronic pressure ulcers include time away from work, expensive at-home nursing care, prolonged hospitalization and surgery, potential infections, and in severe cases, death. A recent study determined that when incidence and costs are combined, pressure ulcers are the most costly medical error in the United States, and that at least 90% of pressure ulcers are preventable.
3. Chronic Pain - The prevalence of chronic pain among individuals with SCI is estimated at 60-65%, but the upper limit may be as high as 90%.Chronic pain interferes with rehabilitation, daily activities, sleep, ability to work, and reintegration into society, and has a substantial impact on quality of life and mental health, often leading to depression and occasionally suicide. Reducing the incidence and severity of secondary complications will have an even greater economic impact, as such advances will reduce the health care costs for individuals with other chronic health conditions, including multiple sclerosis, spina bifida, muscular dystrophy, cerebral palsy, cystic fibrosis, and rheumatoid arthritis.