Objective: To study the epidemiology of traumatic spinal cord injuries in Iceland, that have caused wheelchair-bound disability. To evaluate the frequency of medical complications in this group of patients both during the acute- and rehabilitation-stage as well as after discharge. To study the present condition and problems related to the urinary tract 1-23 years after the injury.
Material and methods: Medical records of all wheelchair-bound traumatic spinal cord injured individuals in Iceland in 1973-1996 were reviewed and the frequency of various medical complications recorded. Long-term complications were assessed by personal interviews. Urodynamic investigations were performed and the present kidney morphology and function studied by various radiological methods.
Results: The annual incidence of studied spinal cord injuries was 8:1,000,000. During the acute- and rehabilitation-stage the following complications were encountered; 14 patients (29%) got pressure sores, eight (17%) deep vein thrombosis, six (12%) pneumonia and five (10%) pulmonary embolism. In the follow-up after discharge and mean follow-up time of 14 years, 19 (54%) have had pressure sores, 16 (46%) have had one to four urinary tract infections each year, nine (26%) more than four. Nineteen patients (56%) complained of urinary incontinance and 18 (52%) had a history of urinary tract stones. One patient had lost a kidney due to reflux. Pathological findings were found in one third of patients who came for upper urinary tract image studies. Maximal detrusor pressure over 60 cmHbO was recorded in 12 (44%) patients and bladder capacity under 200 ml in seven (26%). Of those with injury above Th-6, 14 (58%) had experienced symptoms of autonomous dysreflexia, most commonly due to urinary tract infection or distended urinary bladder. Complications were more common among those who use reflex-voiding rather than intermittent catheterisation. One-third of the patients were either advised to change their way of bladder emptying or required pharmacological intervention according to results from urinary tract investigations.
Conclusions: The incidence of traumatic spinal cord injuries in Iceland, which have caused wheelchair-bound disability, is low and has decreased over the past 25 years. Acute and long-term medical complications are, however, common in these patients. A more efficient follow-up program is needed to optimize bladder treatment and to reduce urinary tract and other medical complications in this patient population.