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Page 2 Fracaro et al. Neuroimmunol Neuroinflammation 2020;7:1-12 I http://dx.doi.org/10.20517/2347-8659.2019.009

Figure 1. Number of cases of spinal cord injury according to trauma level. According to the National Spinal Cord Injury Statistical Center
in the United States. The first region of the spine, the cervical region, is the most affected, accounting for more than half (54.45%) of the
total number of cases, followed by the thoracic (34.86%) and lumbar (10.3%) regions. The sacral region is the least injured, accounting
for 0.39% of cases

Spinal Cord Injury Statistical Center, in the United States, there are approximately 17,500 new cases per
year, of which 81% are male. The average age of new cases has changed since the 1970s, from 29 to 43
years old. The main causes are vehicle collisions, falls, violence (mainly gunshot wounds), and sports or
[4]
recreational activities . In 2018, a survey conducted by the same institution about the frequency of SCI
cases according to the level of the spinal cord showed that, of the total of 31,519 cases, 17,162 (54.45%) are
lesions in the cervical region, 10,987 (34.86%) in the thoracic region, 3247 (10.3%) in the lumbar region,
[4]
and 123 (0.39%) in the sacral region [Figure 1].

According to the National Spinal Cord Injury Statistical Center, in the United States, the first region of the
spine, the cervical region, is the most affected, accounting for more than half (54.45%) of the total number
of cases, followed by the thoracic (34.86%) and lumbar (10.3%) regions, while the sacral region is the least
injured, accounting for 0.39% of cases.

SCI results in disruption of the connection between the central nervous system and the rest of the body.
Trauma, disease, and even spinal cord degeneration can compromise the sensory, motor, autonomic,
and reflex functions of affected individuals, and only 0.4% of cases show complete recovery from their
[5]
deteriorated functions . The pathology of SCI results from two stages: (1) primary injury, which triggers
damage to the spinal cord; and (2) secondary injury, characterized by events arising after the initial injury.
Primary injury is usually the determining factor of the severity of the damage and the effects vary according
to the affected site, which may be the cervical, thoracic, thoracolumbar, or sacral lumbar region .
[6]

After trauma, secondary events such as ischemia, anoxia, and inflammation further compromise the
injured tissue. There is the migration of inflammatory cells to the lesion site, which release inflammatory
cytokines; formation of reactive oxygen species (ROS), which lead to DNA damage and protein oxidation;
[6,7]
and mitochondrial malfunction due to ionic imbalance .