Previously healthy patients with traumatic spinal cord injury faced up to 2.5 times the risk of developing chronic disease across multiple organ systems years following the initial injury, according to a recent multicenter cohort study published in JAMA Network Open.

The increased risk was observed even among younger patients and was accompanied by higher all-cause mortality. The researchers wrote that traumatic spinal cord injury (TSCI) "should be conceptualized not only as an acute injury but also as a chronic condition requiring long-term surveillance and management."

Researchers conducted a retrospective cohort study using longitudinal electronic health record data from January 1996 through January 2024 from 2 US health systems: Mass General Brigham and the University of California Health System. Adults aged 18 years or older with TSCI were identified and compared with uninjured control participants matched 3 to 1 by age, sex, and race. To focus on incident disease, patients with preexisting cardiovascular, neurologic, psychiatric, or endocrine diagnoses documented prior to or within 1 year following injury were excluded. The final analytic cohort included 2,749 patients with TSCI and 8,247 matched control participants.

Across both cohorts, TSCI was associated with significantly increased risk of multisystem morbidity. Compared with uninjured controls, patients with injury had higher incidence of hypertension, coronary artery disease, ischemic stroke, diabetes, dementia, seizure disorders, depression, substance misuse, and endocrine conditions, including adrenal insufficiency and erectile dysfunction. Risk increases were substantial across multiple organ systems, with particularly elevated rates of neurologic complications in some patient groups. Elevated risks were observed across spinal injury locations and age strata, including patients aged 18 to 45 years, indicating that younger and previously healthy patients were not protected from long-term systemic sequelae.

As the researchers stated, "These associations were robust across age groups and injury levels as well as after adjusting for comorbid [traumatic brain injury] TBI, suggesting that TSCI independently drives chronic multisystem disease." The study supports long-term, multidisciplinary follow-up following TSCI.

TSCI was also associated with increased all-cause mortality, particularly among patients who developed postinjury cardiovascular, neurologic, psychiatric, or endocrine conditions. The median time to comorbidity onset was approximately 8 years following injury. Adjustment for concurrent TBI and differences in health care utilization did not materially alter the findings.

Several limitations were noted. The study relied on electronic health record data and International Classification of Diseases coding, which may introduce misclassification. The cohorts were derived from large academic health systems, potentially limiting generalizability. Injury severity and overall trauma burden were not available, and some estimates, particularly for rare endocrine outcomes and mortality associations, had wide confidence intervals. The observational design precludes causal inference.

Although the study did not assess interventions, the researchers emphasized that TSCI should be conceptualized as a chronic condition requiring proactive, multidisciplinary long-term care and surveillance, wrote lead study author Ahmad Mashlah, MBBS, of Brigham and Women's Hospital, and colleagues.

Full disclosures can be found in the published study

Source: JAMA Network Open