Spinal fractures and spinal cord injuries: Incidence, epidemiological characteristics and survival

Thesis event information

Date and time of the thesis defence

Place of the thesis defence

Leena Palotie auditorium (101A), Aapistie 5 A, Oulu. Remote access: https://oulu.zoom.us/j/68565404788?pwd=UmxUT256YzRDUXdBMVdWMUFBeDRFdz09

Topic of the dissertation

Spinal fractures and spinal cord injuries: Incidence, epidemiological characteristics and survival

Doctoral candidate

Medical doctor Ville Niemi-Nikkola

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, Department of Medical Rehabilitation, Oulu University Hospital

Subject of study



Professor Jari Arokoski, University of Helsinki


Professor Mauri Kallinen, University of Oulu

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Spinal fractures and spinal cord injuries : Incidence, epidemiological characteristics and survival

Trauma to the spine can have serious consequences, such as traumatic spinal fracture, traumatic spinal cord injury or both. In addition to traumatic causes, the spinal cord can also be injured due to non-traumatic causes, referred to as a ‘non-traumatic spinal cord injury’.

The aim of this thesis was to reveal the epidemiological characteristics of traumatic spinal injuries in Northern Finland, the long-term mortality and causes of death after traumatic spinal fractures and the epidemiological characteristics of non-traumatic spinal cord injuries in Finland. The study sample consisted of 971 traumatic spinal injury patients and 947 traumatic spinal fracture patients treated in Oulu University Hospital between 2007 and 2011, and 430 non-traumatic spinal cord injury patients treated in Tampere University Hospital and Oulu University Hospital in a four-year period between 2012 and 2016.

The annual incidence of traumatic spinal injury in Northern Finland was 26/100,000. Low falls were the most common trauma mechanism, which differed from most previous studies. They caused a majority of the injuries in older age groups (i.e., over 60 years old). In contrast, in younger age groups (i.e., under 45 years old), road traffic accidents were clearly overrepresented.

Mortality after traumatic spinal fracture was increased in all age groups compared to the general population, varying from threefold in those over 65 years old to twentyfold in those under 30 years old. Low fall as a trauma mechanism increased the hazard for death in the long term significantly compared to high-energy mechanisms.

The incidence of non-traumatic spinal cord injury was 54/1,000,000 per year, which was remarkably higher than that reported in previous international results. This indicates that the centralisation of spinal cord injury care in Finland in 2011 has made possible the study of the entire non-traumatic spinal cord injury patient group. Degenerative diseases were the most common aetiology, followed by malignant and benign neoplasms.

The main targets for traumatic spinal injury prevention should be low falls in the elderly and road traffic injuries in the younger population. The mortality after traumatic spinal fracture is high and seems to be comparable to the mortality after hip fracture reported in previous international studies. Patients sustaining spinal fracture due to low falls need special attention in post-trauma care due to high post-traumatic mortality.

The incidence of non-traumatic spinal cord injury was higher than excepted. The reported high incidence indicates that study designs should be carefully considered in future international studies.
Last updated: 1.3.2023