Original research| Volume 100, ISSUE 10, P1872-1880, October 2019

Survival in 222 Patients With Severe CSCI: An 8-Year Epidemiologic Survey in Western China

Published:January 23, 2019DOI:


      • The authors conducted a survival analysis on 222 patients who suffered from severe cervical spinal cord injury (CSCI) in Western China.
      • Survival rates and mortality risk factors were calculated by the product limit (Kaplan-Meier) method and the Cox model.
      • In the current study, the results demonstrated that 4 predictors were closely related to mortality: age, higher neurologic level, ventilator dependence, and treatment options. Timing to surgery is the main risk factor for mortality in patients with CSCIs.
      • Better understanding of the predictors could possibly contribute to the improvement of survival rates.



      To assess the survival and the predictors of mortality in patients with severe cervical spinal cord injuries (CSCI).


      Retrospective study.


      From January 1, 2010, to May 31, 2018, patients who suffered from severe CSCIs in Western China were enrolled in this study (N=222).


      Not applicable.

      Main Outcome Measures

      Survival rates and mortality risk factors. Measures were calculated by the product-limit method (Kaplan-Meier) and the Cox model.


      The overall 1-year, 3-year, 5-year, and 8-year postoperative mortalities were 24.4%, 30.6%, 33.3%, 36.2%, and 39.0%, respectively. Most deaths occurred within 36 months after the injury. According to the Cox proportional hazards model, the significant predictors of survival were as follows: (1) age; (2) neurologic level; (3) treatment options (surgical or conservative); (4) ventilator support (P<.05). The 8-year mortality for older patients (>50y) was 50.2%, which was significantly higher than that for younger patients (32.4%, <50y). The risk of death was 2.053 times higher in higher levels of injury (C1-C4) than in lower levels of injury (C5-C8) (P<.05). Compared with conservative treatment, patients who received surgical treatment (either anterior or posterior decompression) had a lower risk of death (P<.05). No significant difference was detected in the risk of death between early surgery (<3d) and mid-term surgery (3-7d) (P>.05). However, patients who received late-term surgery (>7d) had a higher mortality risk (P<.05). The overall 8-year mortality risk of patients who needed ventilator support was much higher than those who did not need ventilator support (P<.05).


      Age, neurologic level, ventilator dependence, treatment options, and timing to surgery were main risk factors for mortality in patients with severe CSCIs. Better understanding of the predictors for survival could possibly contribute to the improvement of survival rates.


      List of abbreviations:

      AIS (ASIA Impairment Scale), CSCI (cervical spinal cord injury), RR (risk ratio), SCI (spinal cord injury)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Geisler F.H.
        • Coleman W.P.
        • Benzel E.
        • Ducker T.
        • Hurlbert R.J.
        Spinal cord injury.
        Lancet. 2002; 360: 1883-1884
        • Snoek G.J.
        • IJzerman M.J.
        • Hermens H.J.
        • Maxwell D.
        • Biering-Sorensen F.
        Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics.
        Spinal Cord. 2004; 42: 526-532
        • Shao J.
        • Zhu W.
        • Chen X.
        • et al.
        Factors associated with early mortality after cervical spinal cord injury.
        J Spinal Cord Med. 2011; 34: 555-562
        • Clayton J.L.
        • Harris M.B.
        • Weintraub S.L.
        • et al.
        Risk factors for cervical spine injury.
        Injury. 2012; 43: 431-435
        • National Spinal Cord Injury Statistical Center
        Spinal cord injury facts and figures at a glance.
        J Spinal Cord Med. 2014; 37: 355-356
        • Alander D.H.
        • Andreychik D.A.
        • Stauffer E.S.
        Early outcome in cervical spinal cord injured patients older than 50 years of age.
        Spine (Phila Pa 1976). 1994; 19: 2299-2301
        • Yugue I.
        • Okada S.
        • Ueta T.
        • et al.
        Analysis of the risk factors for tracheostomy in traumatic cervical spinal cord injury.
        Spine (Phila Pa 1976). 2012; 37: E1633-E1638
        • Chamberlain J.D.
        • Meier S.
        • Mader L.
        • von Groote P.M.
        • Brinkhof M.W.
        Mortality and longevity after a spinal cord injury: systematic review and meta-analysis.
        Neuroepidemiology. 2015; 44: 182-198
        • Hartkopp A.
        • Brønnum-Hansen H.
        • Seidenschnur A.M.
        • Biering-Sorensen F.
        Survival and cause of death after traumatic spinal cord injury. A long-term epidemiological survey from Denmark.
        Spinal Cord. 1997; 35: 76-85
        • Zeilig G.
        • Dolev M.
        • Weingarden H.
        • Blumen N.
        • Shemesh Y.
        • Ohry A.
        Long-term morbidity and mortality after spinal cord injury: 50 years of follow-up.
        Spinal Cord. 2000; 38: 563-566
        • Savic G.
        • Devivo M.J.
        • Frankel H.L.
        • Jamous M.A.
        • Soni B.M.
        • Charlifue S.
        Long-term survival after traumatic spinal cord injury: a 70-year British study.
        Spinal Cord. 2017; 55: 651-658
        • Whiteneck G.G.
        • Charlifue S.W.
        • Frankel H.L.
        • et al.
        Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago.
        Paraplegia. 1992; 30: 617-630
        • Chamberlain J.D.
        • Gmünder H.P.
        • Hug K.
        • et al.
        Differential survival after traumatic spinal cord injury: evidence from a multi-center longitudinal cohort study in Switzerland.
        Spinal Cord. 2018; 56: 920-930
        • Krause J.S.
        • Newman J.C.
        • Clark J.M.R.
        • Dunn M.
        The natural course of spinal cord injury: changes over 40 years among those with exceptional survival.
        Spinal Cord. 2017; 55: 502-508
        • Barman A.
        • Shanmugasundaram D.
        • Bhide R.
        • et al.
        Survival in persons with traumatic spinal cord injury receiving structured follow-up in South India.
        Arch Phys Med Rehabil. 2014; 95: 642-648
        • Li H.L.
        • Xu H.
        • Li Y.L.
        • et al.
        Epidemiology of traumatic spinal cord injury in Tianjin, China: an 18-year retrospective study of 735 cases.
        J Spinal Cord Med. 2018; : 1-13
        • Li J.
        • Liu G.
        • Zheng Y.
        • et al.
        The epidemiological survey of acute traumatic spinal cord injury (ATSCI) of 2002 in Beijing municipality.
        Spinal Cord. 2011; 49: 777-782
        • Kirshblum S.C.
        • Burns S.P.
        • Biering-Sorensen F.
        • et al.
        International standards for neurological classification of spinal cord injury.
        J Spinal Cord Med. 2011; 34: 535-546
      1. Spinal cord injury (SCI) 2016 facts and figures at a glance.
        J Spinal Cord Med. 2016; 39: 493-494
        • Jain N.B.
        • Ayers G.D.
        • Peterson E.N.
        • et al.
        Traumatic spinal cord injury in the United States, 1993-2012.
        JAMA. 2015; 313: 2236-2243
        • Catz A.
        • Thaleisnik M.
        • Fishel B.
        • et al.
        Survival following spinal cord injury in Israel.
        Spinal Cord. 2002; 40: 595-598
        • Hagen E.M.
        • Lie S.A.
        • Rekand T.
        • Gihus N.E.
        • Gronning M.
        Mortality after traumatic spinal cord injury: 50 years of follow-up.
        J Neurol Neurosurg Psychiatry. 2010; 81: 368-373
        • Ahoniemi E.
        • Pohjolainen T.
        • Kautiainen H.
        Survival after spinal cord injury in Finland.
        J Rehabil Med. 2011; 43: 481-485
        • Middleton J.W.
        • Dayton A.
        • Walsh J.
        • Rutkowski S.B.
        • Leong G.
        • Duong S.
        Life expectancy after spinal cord injury: a 50-year study.
        Spinal Cord. 2012; 50: 803-811
        • Cao Y.
        • Selassie A.W.
        • Krause J.S.
        Risk of death after hospital discharge with traumatic spinal cord injury: a population-based analysis, 1998-2009.
        Arch Phys Med Rehabil. 2013; 94: 1054-1061
        • Leng Y.X.
        • Nie C.Y.
        • Yao Z.Y.
        • Zhu X.
        [Analysis of the risk factors for early death in acute severe traumatic cervical spinal cord injury].
        Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2013; 25 ([Chinese]): 294-297
        • Hagen E.M.
        • Faerestrand S.
        • Hoff J.M.
        • Rekand T.
        • Gronning M.
        Cardiovascular and urological dysfunction in spinal cord injury.
        Acta Neurol Scand Suppl. 2011; 191: 71-78
        • Liang H.W.
        • Wang Y.H.
        • Lin Y.N.
        • Wang J.D.
        • Jang Y.
        Impact of age on the injury pattern and survival of people with cervical cord injuries.
        Spinal Cord. 2001; 39: 375-380
        • Alander D.H.
        • Parker J.
        • Stauffer E.S.
        Intermediate-term outcome of cervical spinal cord-injured patients older than 50 years of age.
        Spine (Phila Pa 1976). 1997; 22: 1189-1192
        • Fielingsdorf K.
        • Dunn R.N.
        Cervical spine injury outcome--a review of 101 cases treated in a tertiary referral unit.
        S Afr Med J. 2007; 97: 203-207
        • Daneshvar P.
        • Roffey D.M.
        • Brikeet Y.A.
        • Tsai E.C.
        • Bailey C.S.
        • Wai E.K.
        Spinal cord injuries related to cervical spine fractures in elderly patients: factors affecting mortality.
        Spine J. 2013; 13: 862-866
        • Bracken M.B.
        • Shepard M.J.
        • Collins W.F.
        • et al.
        A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal cord injury. Results of the Second National Acute Spinal Cord Injury Study.
        N Engl J Med. 1990; 322: 1405-1411
        • Watt J.W.
        • Wiredu E.
        • Silva P.
        • Meehan S.
        Survival after short- or long-term ventilation after acute spinal cord injury: a single-centre 25-year retrospective study.
        Spinal Cord. 2011; 49: 404-410
        • Liebscher T.
        • Niedeggen A.
        • Estel B.
        • Seidl R.O.
        Airway complications in traumatic lower cervical spinal cord injury: a retrospective study.
        J Spinal Cord Med. 2015; 38: 607-614
        • Yang X.X.
        • Huang Z.Q.
        • Li Z.H.
        • Ren D.F.
        • Tang J.G.
        Risk factors and the surgery affection of respiratory complication and its mortality after acute traumatic cervical spinal cord injury.
        Medicine (Baltimore). 2017; 96e7887
        • Wilson J.R.
        • Singh A.
        • Craven C.
        • et al.
        Early versus late surgery for traumatic spinal cord injury: the results of a prospective Canadian cohort study.
        Spinal Cord. 2012; 50: 840-843
        • Bourassa-Moreau É.
        • Mac-Thiong J.M.
        • Li A.
        • et al.
        Do Patients with complete spinal cord injury benefit from early surgical decompression? Analysis of neurological improvement in a prospective cohort study.
        J Neurotrauma. 2016; 33: 301-306
        • Grassner L.
        • Wutte C.
        • Klein B.
        • et al.
        Early decompression (<8h) after traumatic cervical spinal cord injury improves functional outcome as assessed by spinal cord independence measure after one year.
        J Neurotrauma. 2016; 33: 1658-1666
        • McKinley W.
        • Meade M.A.
        • Kirshblum S.
        • Barndard B.
        Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injury.
        Arch Phys Med Rehabil. 2004; 85: 1818-1825
        • Liu Y.
        • Shi C.G.
        • Wang X.W.
        • et al.
        Timing of surgical decompression for traumatic cervical spinal cord injury.
        Int Orthop. 2015; 39: 2457-2463
        • Liu J.M.
        • Long X.H.
        • Zhou Y.
        • Peng H.W.
        • Liu Z.L.
        • Huang S.H.
        Is urgent decompression superior to delayed surgery for traumatic spinal cord injury? A meta-analysis.
        World Neurosurg. 2016; 87: 124-131
        • Dvorak M.F.
        • Fisher C.G.
        • Fehlings M.G.
        • et al.
        The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system.
        Spine (Phila Pa 1976). 2007; 32: 2620-2629
        • Spivak J.M.
        • Weiss M.A.
        • Cotler J.M.
        • Call M.
        Cervical spine injuries in patients 65 and older.
        Spine (Phila Pa 1976). 1994; 19: 2302-2306
        • Wang H.
        • Xiang Q.
        • Li C.
        • Zhou Y.
        Epidemiology of traumatic cervical spinal fractures and risk factors for traumatic cervical spinal cord injury in China.
        J Spinal Disord Tech. 2013; 26: E306-E313