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Page 2 of 11 Merritt et al. Neuroimmunol Neuroinflammation 2019;6:9 I http://dx.doi.org/10.20517/2347-8659.2019.15

INTRODUCTION
To begin a discussion of the economic impact of traumatic spinal cord injury (TSCI), it becomes necessary
to first have an understanding of the epidemiology and disease burden of TSCI. TSCIs are sustained
following major traumatic events, such as falls, motor vehicle accidents, or acts of violence. TSCIs are
life-changing, economically impactful traumas that are estimated globally to affect 13 new individuals
per 100,000 per year. But this incidence was found to double in North America, affecting nearly 26 new
[1]
individuals per 100,000 per year . The National Spinal Cord Injury Statistical Center, which is both the
longest running and largest database containing the specifics of TSCIs in the United States, estimates
the incidence of new TSCIs to be roughly 40 cases per one million in the United States, or roughly
[2]
about 12,000 new cases per year . The incidence of TSCI in the United States has historically been held
constant, with the largest increases in incidence being observed in the elderly population in the specific
[3,4]
context of an increase in the number of falls as an individual ages . The prevalence of TSCI in the
United States is estimated to be approximately 273,000, within a range of 238,000 to 332,000 . Within the
[2]
prevalent population as a whole, more severe injuries were observed in younger individuals as compared
to those living to older age with incomplete and/or lower level injuries with resulting high degrees of
[5]
independence . The average age at the time of spinal cord injury is estimated to be 42.6 years of age with
males accounting for 80.7% of new cases, vastly outnumbering their female counterparts.

[6]
Those with TSCIs have recently been found to be living longer, when compared to historical trends .
Vehicle crashes remain the leading cause of injury, followed by falls, and then acts of violence (i.e.,
gunshot wounds) [Figure 1] . The neurological deficits sustained following a TSCI are categorized by its
[2]
corresponding American Spinal Injury Association (ASIA) score, ranging from A to E with A indicating
profound deficit and E indicating normal function [Table 1] . The extent of injuries varies as well, with
[7]
incomplete tetraplegia being the leading extent of injury, followed by incomplete paraplegia, complete
[2]
paraplegia, and finally complete tetraplegia [Figure 2] . The limitations on an individual’s activities of daily
living were found to be largely determined by the location and completeness of the injury sustained, where
total hours of care were dependent upon injury level and severity . TSCIs exact a heavy financial burden
[8]
both in the acute care setting as well as within the context of longer-term rehabilitation that often follows
the initial injury . The costs associated with TSCIs are greatly affected by both the patient’s extent of
[9]
injury and subsequent degree of disability. Unsurprisingly, the overall life expectancy for those individuals
sustaining a TSCI remain significantly below the average life expectancy in the United States . An
[10]
understanding of the epidemiological burden of TSCI in the United States warrants a further discussion on
the cost, reimbursement, and subsequent disability associated with such an economically, medically, and
psychologically impactful event.

ACUTE CARE COSTS FOLLOWING TRAUMATIC SPINAL CORD INJURY
Immediately following a TSCI, the vast majority of patients will promptly seek medical care consisting
of both surgical stabilization and vertebral decompression [11-14] . The high acuity of TSCIs often exacts
a heavy financial burden in addition to a life-altering disability for these patients. In the United States,
approximately 50% of TSCI patients have their medical costs covered through a private insurer. Medicaid,
a state-run medical insurance provider for financially disadvantaged patients, covers 28% of those having
sustained a TSCI. The remaining population has their medical costs covered through Medicare or the
Veterans Health Administration (VHA) . The average cost for the initial injury and recovery phase,
[13]
[12]
termed the acute phase, can run $142,366 . The majority of these charges will be covered through a
patient’s primary medical insurance. Most patients, with the exception of eligible military veterans through
the VHA, are often left with high co-pays that place an additional undue financial burden on the recovery
process.