Incidence and causes of traumatic and non-traumatic spinal cord injury in Salzburg, Austria: a multi-center hospital network-based study

INTRODUCTION: Spinal cord injury (SCI) causes substantial disability and healthcare burden. While Austrian data are available for traumatic SCI, incidence and causes of non-traumatic SCI have not been reported previously. This study aims to determine the incidence and causes of traumatic and non-traumatic SCI in Salzburg, Austria, from 2013 to 2023.

METHODS: We retrospectively screened hospital databases from Salzburg County Hospitals (SALK) and the regional trauma hospital (AUVA) using an ICD-based algorithm. This hospital network captures the majority of SCI care in the region; however, cases managed exclusively outside this network may not be captured. Cases were included if SCI was confirmed by MRI or medical documentation and the index event occurred during 2013-2023. Data were extracted into a validated REDCap instrument. Incidence was calculated for Salzburg residents; non-resident cases were analyzed separately for healthcare burden.

RESULTS: A total of 587 SCI cases were identified, including 99 traumatic (16.8%) and 488 non-traumatic (83.2%). The average incidence was 9.7/100,000/year (traumatic: 1.6; non-traumatic: 8.1). The cohort had a median age of 62 years; male-to-female ratio was 2.96 for traumatic and 1.02 for non-traumatic cases. Falls (52.5%) were the leading traumatic cause, followed by transport (24.2%) and sports injuries (19.2%). Multiple sclerosis (24.8%) was the most frequent non-traumatic etiology, followed by degenerative disorders, neoplasms, and infections. Nearly half of all lesions were cervical, with C5-C8 most commonly affected. From 2020 onward, SCI incidence declined sharply, temporally coinciding with the COVID-19 pandemic.

CONCLUSION: SCI incidence in Salzburg (9.7/100,000) was higher than earlier Austrian estimates due to inclusion of non-traumatic cases, which comprised over 80% of all SCIs. Falls and degenerative/inflammatory conditions were major contributors. Preventive strategies should address both traumatic and non-traumatic causes, and a prospective national registry is warranted.