OUTLOOK THE SPINE
SENSATION AND LOSS
An injury to the spine — the long bony assemblage that supports the upper body and the spinal cord that carries nerve signals — can be grim and costly. By Bill Cannon.
TO SERVE AND PROTECT Each vertebral section (left) — cervical, thoracic, lumbar and sacral — corresponds to nerve sensations in a particular region of the body, a feature that allows pinpointing the location of spinal injuries (right). The numbers in circles refer to the vertebra where the nerves arise or return.
C2
C3
Cervical Vertebrae C1–C8 Nerves that emerge between these vertebrae serve the head to the hands, and much of the arms in between.
C4
T2
Thoracic Vertebrae T1–T12 The dozen thoracic vertebrae provide entry and exit portals for nerves that recognize sensations from and control movements of the torso, as well as the underside of the arms.
T3 T4
C5
T5 T6 T7
T1 T8
Lumbar Vertebrae L1–L5 The flexible spine's bottom region provides sensory and motor control from the hips to the toes.
C6
T9 T10
Sacrum S1–S5 Fused with the pelvis, the sacral portion of the spinal cord controls the rear portion of the legs, from the heels to the hips.
T11 T12
L1
C7
L2 Each segment of the spine consists of a vertebra composed of bone and cartilaginous discs that provide cushioning between the vertebrae. The spinal cord runs inside the vertebrae and nerves exit and enter the cord between the vertebrae.
S3 L3
Cartilaginous disc
Bone
S2
Spinal nerve root
more than three times the pressure in a racing bicycle tyre, failed to rupture a spinal disc in one study.
Spinal cord
L4
S1
L5
S 2 | NAT U R E | VO L 5 0 3 | 1 4 NOV E M B E R 2 0 1 3
© 2013 Macmillan Publishers Limited. All rights reserved
C8
THE SPINE OUTLOOK
Traumatic spinal cord injuries happen around the world, but the causes vary. Data gathered during the years 1959 to 2011 detail the causes of injury by World Health Organization regions. Differences in regional lifestyles and demographics account for some variation. There are 1 billion neurons in the human spinal cord.
UNITED STATES / CANADA
WESTERN EUROPE
CENTRAL EUROPE
In Taiwan, 65% of spinal injuries from land transport involve two-wheeled vehicles.
EASTERN EUROPE EAST ASIA
In the United States, 86% of people sustaining a spinal cord injury survive 10 years or longer.
WESTERN SUB-SAHARAN AFRICA
ASIA PACIFIC
NORTH AFRICA/MID. EAST
SOUTH ASIA
OCEANIA SOUTH-EAST ASIA
LATIN AMERICA SOUTHERN SUB-SAHARAN AFRICA
Aetiology of injury median/average percentile
AUSTRALASIA
The world's highest proportion of spinal cord injuries from gunshots comes from South Africa.
Land transport Falls Sports Violence Work
In Australia, diving causes 63% of the water-related spinal cord injuries.
COST AND CONSEQUENCES The initial cost of the most severe spinal injuries can top US$1 million per patient in the first year alone and cost more than $180,000 a year thereafter, pushing lifetime costs for someone 25 years old at the time of injury to $4.6 million (lower left). With improvements in medical treatment, survival rates for people suffering injuries in the first four cervical vertebrae have improved considerably (lower right).
100
$181k
High Tetraplegia (C1–C4)
1990–2004
$4.6M $111k
Low Tetraplegia (C5–C8)
First year cost Subsequent years Lifetime costs
$755k $3.4M 0
1M
2M 3M Cost in US$
4M
5M
Survival (%)
$1.04M
90
80
1980–1989 1973–1979
70 0
12 Months following a C1–C4 spinal injury
24
1 4 NOV E M B E R 2 0 1 3 | VO L 5 0 3 | NAT U R E | S 3
© 2013 Macmillan Publishers Limited. All rights reserved
A WORLD OF HURT: LEE BB, ET AL SPINAL CORD (26 FEBRUARY 2013); DOI: 10.1038/SC.2012.158. COST AND CONSEQUENCES: LEFT GRAPH; NATIONAL SPINAL CORD INJURY STATISTICAL CENTER AT THE UNIVERSITY OF ALABAMA AT BIRMINGHAM. RIGHT GRAPH; STRAUSS, D. J. ARCH PHYS MED REHABIL. 87(8): 1079–1085 (2006).
A WORLD OF HURT
SENSATION AND LOSS
An injury to the spine — the long bony assemblage that supports the upper body and the spinal cord that carries nerve signals — can be grim and costly. By Bill Cannon.
TO SERVE AND PROTECT Each vertebral section (left) — cervical, thoracic, lumbar and sacral — corresponds to nerve sensations in a particular region of the body, a feature that allows pinpointing the location of spinal injuries (right). The numbers in circles refer to the vertebra where the nerves arise or return.
C2
C3
Cervical Vertebrae C1–C8 Nerves that emerge between these vertebrae serve the head to the hands, and much of the arms in between.
C4
T2
Thoracic Vertebrae T1–T12 The dozen thoracic vertebrae provide entry and exit portals for nerves that recognize sensations from and control movements of the torso, as well as the underside of the arms.
T3 T4
C5
T5 T6 T7
T1 T8
Lumbar Vertebrae L1–L5 The flexible spine's bottom region provides sensory and motor control from the hips to the toes.
C6
T9 T10
Sacrum S1–S5 Fused with the pelvis, the sacral portion of the spinal cord controls the rear portion of the legs, from the heels to the hips.
T11 T12
L1
C7
L2 Each segment of the spine consists of a vertebra composed of bone and cartilaginous discs that provide cushioning between the vertebrae. The spinal cord runs inside the vertebrae and nerves exit and enter the cord between the vertebrae.
S3 L3
Cartilaginous disc
Bone
S2
Spinal nerve root
more than three times the pressure in a racing bicycle tyre, failed to rupture a spinal disc in one study.
Spinal cord
L4
S1
L5
S 2 | NAT U R E | VO L 5 0 3 | 1 4 NOV E M B E R 2 0 1 3
© 2013 Macmillan Publishers Limited. All rights reserved
C8
THE SPINE OUTLOOK
Traumatic spinal cord injuries happen around the world, but the causes vary. Data gathered during the years 1959 to 2011 detail the causes of injury by World Health Organization regions. Differences in regional lifestyles and demographics account for some variation. There are 1 billion neurons in the human spinal cord.
UNITED STATES / CANADA
WESTERN EUROPE
CENTRAL EUROPE
In Taiwan, 65% of spinal injuries from land transport involve two-wheeled vehicles.
EASTERN EUROPE EAST ASIA
In the United States, 86% of people sustaining a spinal cord injury survive 10 years or longer.
WESTERN SUB-SAHARAN AFRICA
ASIA PACIFIC
NORTH AFRICA/MID. EAST
SOUTH ASIA
OCEANIA SOUTH-EAST ASIA
LATIN AMERICA SOUTHERN SUB-SAHARAN AFRICA
Aetiology of injury median/average percentile
AUSTRALASIA
The world's highest proportion of spinal cord injuries from gunshots comes from South Africa.
Land transport Falls Sports Violence Work
In Australia, diving causes 63% of the water-related spinal cord injuries.
COST AND CONSEQUENCES The initial cost of the most severe spinal injuries can top US$1 million per patient in the first year alone and cost more than $180,000 a year thereafter, pushing lifetime costs for someone 25 years old at the time of injury to $4.6 million (lower left). With improvements in medical treatment, survival rates for people suffering injuries in the first four cervical vertebrae have improved considerably (lower right).
100
$181k
High Tetraplegia (C1–C4)
1990–2004
$4.6M $111k
Low Tetraplegia (C5–C8)
First year cost Subsequent years Lifetime costs
$755k $3.4M 0
1M
2M 3M Cost in US$
4M
5M
Survival (%)
$1.04M
90
80
1980–1989 1973–1979
70 0
12 Months following a C1–C4 spinal injury
24
1 4 NOV E M B E R 2 0 1 3 | VO L 5 0 3 | NAT U R E | S 3
© 2013 Macmillan Publishers Limited. All rights reserved
A WORLD OF HURT: LEE BB, ET AL SPINAL CORD (26 FEBRUARY 2013); DOI: 10.1038/SC.2012.158. COST AND CONSEQUENCES: LEFT GRAPH; NATIONAL SPINAL CORD INJURY STATISTICAL CENTER AT THE UNIVERSITY OF ALABAMA AT BIRMINGHAM. RIGHT GRAPH; STRAUSS, D. J. ARCH PHYS MED REHABIL. 87(8): 1079–1085 (2006).
A WORLD OF HURT
