Survival following spinal cord injury in Israel

Background: Survival following spinal cord injury (SCI) has greatly improved since the unsuccessful attempts to repair the damaged spinal cord were replaced by systematic prevention and treatment of complications caused by the neural damage. Objective: To evaluate the main outcome measures in patients with spinal cord injury. Design: Retrospective cohort study. Setting: Loewenstein Rehabilitation Hospital, the major referral center for rehabilitation medicine for hospitals throughout Israel. Subjects: 250 consecutive patients, injured between 1959 and 1992. Main outcome measures: Survival rates and mortality risk factors. Method: Demographic, clinical, and mortality data were collected from the hospital charts and from the Population Registry of the Israel Ministry of Internal Affairs. Survival rates were estimated using the product limit (Kaplan-Meyer) method, and their association with known risk factors was analyzed with the Cox proportional hazard model. Results: The survival rate after injury was 81% after 10 years, 75% after 20 years, and 62% after 30 years, and 50% after about 36.5 years. Survival was found to be negatively associated with age (P=0.01) and with high spinal level of injury (P=0.003). Conclusions: Survival rates in the studied population are similar to those reported in other countries, and are close to those of the general population living in Israel in the same time period. The study demonstrates that developing countries can reach survival rates comparable to those of developed countries, and may contribute to better survival predictions of patients with SCI.