Spinal Cord Injury


Approximately 17,900 spinal cord injuries (SCI) occur in the United States each year. The estimated number of people living with SCI in the United States is approximately 296,000 persons, with a range from 252,000 to 373,00 persons.  Lengths of stay in the hospital acute care unit have declined from 24 days in the 1970s to 11 days in 2020. Lengths of stay in rehabilitation have also declined from 98 days in the 1970s to 30 days in 2020.  Mortality rates due to SCI are significantly higher during the first year after injury than during subsequent years. The most common cause of death for persons with SCI are pneumonia and septicemia.  Effects of SCI can include depression, chronic pain, pressure injuries (pressure sores), spasticity, changes in bowel and bladder function, respiratory issues, and changes in sexual functioning.

Spinal Cord Injury Facts

What is the Spinal Cord?

The spine (aka backbone) is a linked column of bones running from the head down to the lower back. The spinal cord, made of soft tissue and surrounded by bones (vertebrae), extends from the base of the brain, down your back to your buttocks. The spinal cord and brain together make up the central nervous system. The spinal cord carries messages between the brain and the rest of the body. These messages from the spinal cord coordinate the body’s movement and sensation.

Each vertebra is numbered and grouped into 5 regions.

  • There are 7 cervical vertebrae in the cervical region.
  • There are 12 thoracic vertebrae in the thoracic region.
  • There are 5 lumbar vertebrae in the lumbar region.
  • There are 5 sacral vertebrae, which are fused as one bone and known as the sacrum, in the sacral region.
  • There are 3 to 5 coccygeal vertebrae, which are fused as one bone and known as the coccyx (commonly known as the tailbone), in the coccygeal region.

What is an SCI?

An SCI usually begins with a sudden, traumatic blow to the spine that fractures or dislocates vertebrae. The damage begins at the moment of injury when displaced bone fragments, disc material, or ligaments bruise or tear into spinal cord tissue. Most injuries to the spinal cord do not completely sever it. Instead, an injury is more likely to cause fractures and compressions of the vertebrae, which then crush and destroy axons–extensions of nerve cells that carry signals up and down the spinal cord between the brain and the rest of the body. An injury to the spinal cord can damage a few, many, or almost all these axons. Some injuries will allow almost complete recovery. Others will result in complete paralysis.

How many people have an SCI in Hawaii?

From 2015 to 2019, Hawaii averaged 159 SCIs annually, including 125 hospitalizations and 34 emergency department (ED) visits in Hawaii.

Figure 1: Annual Number of Hospital Treatments for SCI in Hawaii, by Level of Care, 2015-2019.
Chart of hospital treatments for SCI in Hawaii by level of care

Figure 1 – Long Description

What are the leading causes of SCI in Hawaii?

From 2015 to 2019 (annual average number), the leading cause of SCI were falls at 33%. 32% were due to ocean activities 13% were occupants involved in a motor vehicle collision, 3% were due to striking, 7% were motorcyclist involved in a motor vehicle collision, and 2% were due to assault.

From 2017 to 2019, the annual average duration for hospitalizations was 14 days and resulted in an approximate average of $158,605 in financial charges ($19.3 million/year).  Each SCI-related ED visit generated approximately $10,939 in financial charges ($0.4 million/year).

Figure 2: Hawaii Trauma Registry: Location (beach) of SCIs from Ocean Activities in Hawaii, 2012-2016.

Hawaii Trauma Registry: Location of Spinal Cord Injury

Figure 2 – Long Description

Risk Factors of SCI

Although a spinal cord injury is usually the result of an accident and can happen to anyone, certain factors may predispose you to a higher risk of sustaining a spinal cord injury, including:

  • Being male. Spinal cord injuries affect a disproportionate number of men, who account for about 80% of all spinal cord injuries.
  • Being between the ages of 16 and 30. You are most likely to suffer a traumatic spinal cord injury if you are between the ages of 16 and 30.
  • Older than 65. Falls cause most injuries in older adults. The overall average age at time of injury is 43 years.
  • Engaging in risky behavior. Diving into shallow water, playing sports without wearing the proper safety gear or not taking proper precautions can lead to spinal cord injuries.
  • Having a bone or joint disorder. A relatively minor injury can cause a spinal cord injury if you have another disorder that affects your bones or joints, such as arthritis or osteoporosis.

SCI Prevention Tips


  • Exercise regularly to increase balance and flexibility
  • Have your doctor or pharmacist review your medications yearly
  • Get an annual eye exam
  • Make your home safer by removing throw rugs, clearing floors and hallways of clutter, and improving the lighting in your home and stairways.

Water-Ocean Activities

  • Swim near a lifeguard and check with lifeguards on current conditions before swimming.
  • STOP, watch, and walk into the water.
  • DON’T dive headfirst into any unknown water.  You never know what’s beneath the surface of the water. Water levels may have shifted, and the water is too shallow for diving.
  • DON’T jump or dive from a cliff, pier, jetty or bridge.
  • Avoid bodysurfing, bodyboarding or surfing straight “over the falls.” Ride the shoulder.
  • In a “wipeout,” land as flat as possible with your hands out in front of you.
  • While bodysurfing, keep an arm out in front of you to protect your head and neck.
  • When in doubt, DON’T DIVE, play it safe!
  • Never turn your back on the ocean.


  • Always wear a seatbelt
  • Avoid distractions, including texting, talking on the phone, eating, disruptive passengers or pets
  • Place children in seatbelts and/or age, height, and weight appropriate safety seats
  • Never drive after drinking alcohol


  • Always wear appropriate clothes, shoes, and safety gear when playing a sport
  • Learn proper techniques and movements used in different sports
  • Avoid hitting your head

SCI Symptoms

Your ability to control your limbs after a spinal cord injury depends on two factors: the place of the injury along your spinal cord and the severity of injury to the spinal cord.

The lowest uninjured part of your spinal cord is referred to as the neurological level of your injury. The severity of the injury is often called “the completeness” and is classified as either of the following:

Complete Incomplete
If all feeling (sensory) and all ability to control movement (motor function) are lost below the spinal cord injury, your injury is called complete. If you have some motor or sensory function below the affected area, your injury is called incomplete. There are varying degrees of incomplete injury.

Additionally, paralysis from a spinal cord injury may be referred to as:

Tetraplegia Paraplegia
Also known as quadriplegia, this means that your arms, hands, trunk, legs, and pelvic organs are all affected by your spinal cord injury. This paralysis affects all or part of the trunk, legs, and pelvic organs.

Your health care team will perform a series of tests to determine the neurological level and completeness of your injury.

Spinal cord injuries of any kind may result in one or more of the following signs and symptoms:

  • Loss of movement
  • Loss or altered sensation, including the ability to feel heat, cold and touch
  • Loss of bowel or bladder control
  • Exaggerated reflex activities or spasms
  • Changes in sexual function, sexual sensitivity, and fertility
  • Pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord
  • Difficulty breathing, coughing, or clearing secretions from your lungs

If You Have an SCI

When to Seek Immediate Medical Attention

If you suspect that someone has a back or neck injury: Emergency signs and symptoms of a spinal cord injury after an accident may include: When to see a doctor:
  • Don’t move the injured person — permanent paralysis and other serious complications may result
  • Call 911 or your local emergency medical assistance number
  • Keep the person still
  • Place heavy towels on both sides of the neck or hold the head and neck to prevent them from moving until emergency care arrives
  • Provide basic first aid, such as stopping any bleeding and making the person comfortable, without moving the head or neck
  • Extreme back pain or pressure in your neck, head or back
  • Weakness, incoordination, or paralysis in any part of your body
  • Numbness, tingling or loss of sensation in your hands, fingers, feet, or toes
  • Loss of bladder or bowel control
  • Difficulty with balance and walking
  • Impaired breathing after injury
  • An oddly positioned or twisted neck or back
  • A serious spinal injury isn’t always immediately obvious. If it isn’t recognized, a more severe injury may occur.
  • Numbness or paralysis may occur immediately or come on gradually as bleeding or swelling occurs in or around the spinal cord.
  • The time between injury and treatment can be critical in determining the extent and severity of complications and the possible extent of expected recovery.