Spinal Trauma in Italy: Actuality and Future Perspectives

According to the current literature, the incidence of spinal trauma with neurological impairment in Italy is estimated to be between 18 and 20 cases per million. Usually the most affected patients are young or middle aged, with a male/female ratio of 3,5-4,1 and the trauma is related to road accidents. Spine trauma is also related to work accidents: falls from a height in 53% of the cases, road accidents during the drive to and from work in 20% of cases. In the elderly population, the main cause is due to home accidents. Spinal Cord Injuries (SCI) are between the main reasons of permanent disability, with a high economic and social expense; their incidence is increasing, due to the different lifestyle and the augmented life expectancy.

Primary prevention could reduce the global incidence of spinal cord injuries. Secondary prevention, with a correct diagnosis and treatment in the early phase might reduce the number of negative outcomes, and improve the quality of life of the patients with SCI. A careful clinical and radiological assessment, associated with an early surgical treatment, are of main importance to improve the prognosis of the patient. The clinical outcome of SCI patients might be improved in specialized centres, with intensive care unit and specific trauma management protocols.

Actuality and future perspectives

According to Fehlings et al. all patients with SCI are at high risk for cardiovascular and respiratory complicances. Moreover the management of patients with acute SCI, whenever possible, in specialized centres is fundamental. In Italy, patients with SCI might refer to different types of structures. The Unipolar Spinal Unit (USU) is a sanitary structure where all the specialists needed for the management of SCI are involved in the same place.

In the Bipolar Spinal Unit (BSU) the emergency phase and the post-acute phase are held in different places. The Dedicated Centres are structures compared to Spinal Units in which the rehabilitative phase is held. The USU represents, therefore, the medical centre of excellence, due to their capability of multidisciplinary management of the patient with SCI. Many specialists are involved and cooperate, such as the neurosurgeon, the neurologist, the anesthetist and the physiotherapist.