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Page 4 of 11 Merritt et al. Neuroimmunol Neuroinflammation 2019;6:9 I http://dx.doi.org/10.20517/2347-8659.2019.15

[2]
Figure 2. A pie chart illustrating the extent of injury following TSCI since 2010 according to the NSCISC. The NSCISC estimated that
nearly half of all TSCI resulted in the extent of injury known as incomplete tetraplegia (blue). Incomplete and complete paraplegia were
similar in prevalence following TSCI (represented by orange and gray, respectively) while complete tetraplegia (yellow) was the least
common extent of injury following TSCI as compared to the other major extent of injury categories. TSCI: traumatic spinal cord injury;
NSCISC: National Spinal Cord Injury Statistical Center

[12]
healthcare costs . Sparsely located hospitals in rural areas ill-equipped to manage complex TSCIs may
underlie the delayed care observed in rural areas [12,19] .

HOSPITAL LENGTH OF STAY FOLLOWING TRAUMATIC SPINAL CORD INJURY
The average hospital LOS following a TSCI was found to be approximately 12 days, twice as long as
patients without TSCI. Interestingly, patients between the ages of 18-29 averaged 13.5 days in the hospital,
while elderly patients (over 60 years old) averaged only 10 days. This is a surprising observation that
[12]
can be attributed to younger age being a major risk factor for more severe forms of TSCI . Surgical
intervention is often necessary for severe TSCIs and is significantly more expensive than conservative
medical management. In a study conducting a cost/benefit analysis in elderly patients with odontoid (C1-C2)
fractures, it was found that the cost of surgical intervention was approximately $50,000 per patient, while
the cost of medical management alone was more akin to $30,000 per patient. When considering the options
between surgical and medical management, it is important to note that patients between the ages of 65-
85 had a favorable increase in quality adjusted life years (QALY) following surgical management. These
patients’ qualities of life improved following surgical management to offset the high costs of care. Patients
over the age of 85 did not see the favorable QALY improvement from surgical intervention, suggesting this
population would have the greatest cost-benefit from conservative medical management as compared to
[20]
surgical intervention . The ASIA score can be utilized as a determinant of emergency room (ER) cost as
well [15,21] . Using this information, TSCI surgical hospital costs can be lowered by trying to target certain age
[22]
groups (under 85) and by attempting surgical intervention sooner .

RECOVERY AND LONG-TERM DISABILITY FOLLOWING TRAUMATIC SPINAL CORD INJURY

Post-injury rehabilitation
TSCI recovery is divided into three major phases: acute, post-acute, and chronic [23,24] . The acute phase is
marked by post-injury care received in the hospital, while post-acute and chronic phases are distinguished