Traumatic spinal cord injury linked to elevated morbidity, mortality
November 13, 2025
2 min read
Key takeaways:
- There was an increased risk for psychiatric conditions in patients with TSCI.
- Researchers said the findings support framing spinal cord injury as a chronic condition.
Traumatic spinal cord injuries were linked to elevated risks for long-term morbidity and mortality, regardless of health prior to injury, underscoring the need for improved longitudinal care, data published in JAMA Network Open show.
“This study fills a major gap by quantifying the long-term, multisystem disease burden after previously healthy traumatic spinal cord injury across two large U.S. health systems and independent of co-occurring brain injury,” Saef Izzy, MD, FNCS, FAAN, assistant professor of neurology at Harvard Medical School and neurologist at Mass General Brigham, told Healio.
Data were derived from Izzy S, et al. JAMA Netw Open. 2025;doi:10.1001/jamanetworkopen.2025.41157.
While there is a robust body of evidence surrounding complications of traumatic spinal cord injury (TSCI), little is understood about the long-term systemic sequelae for the condition, particularly in those who were healthy prior to the injury, Izzy and colleagues wrote.
They sought to examine long-term risks for neuropsychiatric, cardiovascular, and endocrine comorbidities and associated mortality in TSCI, compared with uninjured controls.
Their retrospective cohort study analyzed longitudinal data from a pair of hospital-based registries between January 1996 and January 2004: the Mass General Brigham Research Patient Data Registry (MGB; n = 1,038; median age 44 years; 58% women) and the University of California Health System Data Warehouse (UC; n = 1,111; median age 45 years; 65% men).
All eligible participants were then matched on a 3:1 basis with uninjured controls (MGB; n = 3,114; median age, 43 years; UC; n = 5,133; median age, 45 years) by age, sex and race.
Both datasets were analyzed independently to provide a broader characterization of this population across disparate health care settings and geography, Izzy and colleagues wrote.
The primary endpoints for the study were incidence of 21 conditions among both cohorts and the corresponding matches.
The researchers additionally analyzed data for associations between TSCI, related comorbidities and their association with all-cause mortality with hazard and odds ratios at 95% confidence intervals.
For both cohorts, results showed those with TSCI had higher risks for cardiovascular diseases including hypertension (HR = 1.6 for both MGB and UC) and coronary artery disease (HR = 1.8 for both cohorts), along with an increased risk for neurological diseases including ischemic stroke (MGB, HR = 2.5; UC, HR = 1.6) and seizures (MGB, HR = 2.9; UC, HR = 2.7).
In addition, Izzy and colleagues found an elevated risk for hyperlipidemia in the MGB cohort (HR = 1.5) but not in the UC group vs. uninjured controls.
Data further showed an increased prevalence of psychiatric conditions among individuals with TSCI, including depression (MGB, HR = 2.7; UC, HR = 2.2), with an elevated risk for opioid use disorder reported among both sets of patients.
Additionally, TSCI was linked with a higher risk of adrenal insufficiency (MGB, HR = 2.5; UC, HR = 5.6).
The risk for comorbidities was elevated in patients aged 18 to 45 years among both those with TSCI and healthy matches among the MGB cohort, but with higher rates of both hypertension (HR = 1.5) and ischemic stroke (HR = 2.8) within the TSCI group vs. the UC group. Hazard ratios were similar for both conditions in the UC group.
Finally, results showed that postinjury hypertension (OR = 2), pituitary dysfunction, adrenal insufficiency, depression, substance misuse, seizures and dementia all carried associations with higher mortality.
“The findings support reframing TSCI as a chronic condition and justify proactive, protocolized surveillance (cardiometabolic, endocrine, neurologic and psychiatric) with risk-stratified prevention and management pathways to reduce morbidity and mortality,” Izzy said.
For more information:
Saef Izzy, MD, MBCHB, can be reached at [email protected].
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