Clinical and Functional Evolution of Patients with Spinal Cord Injury in a National Referral Center: A Decade of Clinical, Demographic Results and Associated Factors (2015–2025), with Comparison of Two Cohorts (2005–2012, 2015–2025) and Trends

Abstract

Introduction: Spinal cord injury (SCI) represents one of the most disabling neurological conditions. Although a profile of young individuals with complete traumatic injuries from motor vehicle accidents has historically dominated, population aging and improvements in pre-hospital care suggest a significant epidemiological and clinical transition over the last two decades in Mexico.

Objective: To evaluate the sociodemographic, etiological, and neurological severity transitions, as well as functional recovery at discharge, in patients with SCI admitted to the National Institute of Rehabilitation (INR) across two consecutive decades (2005-2012 vs. 2015-2025).

Methodology: A comparative retrospective cohort study contrasting a historical cohort (2005-2012, n = 433) with a purified modern cohort (2015-2025, n = 1,957; TSCI = 1,126 [57.5%], NTSCI = 831 [42.5%]). Sociodemographic data, injury mechanisms, anatomical level, neurological severity (ASIA/AIS scale), and functional independence (SCIM III) at admission and discharge were analyzed. Chi-square, Wilcoxon signed-rank, and Mann-Whitney U tests were applied (p < 0.05). No references were included.

Results: The modern cohort showed an increase in mean age in both TSCI (43.9 years) and NTSCI (54.7 years). In TSCI, falls rose drastically to 39.3%, displacing motor vehicle accidents (which fell from 43.4% to 10.8%). In NTSCI, degenerative myelopathies rose to 35.6%, displacing neoplastic causes (from 57.4% to 14.7%). A significant reduction in admission neurological severity was observed in TSCI, with complete AIS A injuries dropping from 62.7% historically to 44.2% in the modern cohort (p < 0.001). At discharge, both cohorts showed highly significant in-hospital functional and neurological improvement (Wilcoxon, p < 0.001). The neurological recovery rate (gaining 1 or more AIS grades) was equivalent between groups: 12.4% in NTSCI vs. 11.4% in TSCI (p = 0.61).

Conclusions: A demographic transition toward older patients, a dominant etiological shift to falls and degenerative causes, and lower admission severity suggesting improved pre-hospital care networks are demonstrated. Specialized multidisciplinary rehabilitation at the INR offers an equivalent rate of neurological and functional recovery regardless of the origin of the injury, validating equity in the allocation of therapeutic resources.