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. 2025 Jul 15;20(1):657.
doi: 10.1186/s13018-025-05985-9.

Global epidemiological trends and burden of cervical and subcervical spinal cord injuries, 1990-2021: a multidimensional analysis using global burden of disease data

Wei Liu #  1 , Azhati Samuhaer #  2 , Kunpeng Lin  3 , Mingchen Li  2 , Chunyu Zang  2 , Hongwei Liu  4 , Haixiu Fan  5 , Ke Shi #  6 , Donghai Li #  7
Affiliations

Global epidemiological trends and burden of cervical and subcervical spinal cord injuries, 1990-2021: a multidimensional analysis using global burden of disease data

Wei Liu et al. J Orthop Surg Res. .

Abstract

Background: Cervical spinal cord injury (CSCI) and subcervical spinal cord injury (SSCI) cause substantial motor, sensory, and autonomic dysfunction, with traumatic and non-traumatic etiologies. CSCI (C1-C8) and SSCI (T1-L1) impose severe individual and societal burdens. This study assessed global trends in SCI incidence, prevalence, and years lived with disability (YLDs) from 1990 to 2021.

Methods: Data were drawn from the Global Burden of Disease (GBD) 2021 study. CSCI and SSCI cases were stratified by age, sex, and Socio-demographic Index (SDI). Age-standardized rates (ASR) and estimated annual percentage changes (EAPC) were calculated. Future trends (2022-2050) were projected using ARIMA modeling.

Results: Our analysis revealed clear age-related patterns in SCI burden. Both CSCI and SSCI incidence, prevalence, and YLDs increased with advancing age, with CSCI predominantly affecting middle-aged adults and SSCI rising significantly among the elderly. Males consistently showed higher rates of CSCI and SSCI across both injury types, and significant sex-based differences were observed in YLDs. High-SDI regions experienced gradual decreases in ASR for CSCI, while low-SDI regions exhibited rapid increases in YLDs associated with CSCI, indicating a disparity in healthcare resource allocation. The growth rate of CSCI and SSCI burden was notably higher in low and middle-SDI countries, particularly for SSCI.

Conclusion: Although the overall burden of CSCI and SSCI is stabilizing or declining in certain regions, the global YLDs continue to rise, driven by population aging and insufficient healthcare infrastructure in low-SDI regions. CSCI lead to greater disability, and persistent gender and regional disparities highlight the need for targeted, equitable prevention and rehabilitation strategies.

Keywords: Age-standardized rate; Cervical spinal cord injury; Global Burden of Disease; Socio-demographic index; Subcervical spinal cord injury; Years lived with disability.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The data from the GBD study, which were used in this analysis, are publicly accessible and have undergone de-identification, eliminating the necessity for ethical approval. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Global burden of cervical spinal cord injury across age groups: trends in incidence, prevalence, and YLDs. A Age-standardized rates. B Number of cases. Abbreviation: YLDs, years lived with disability
Fig. 2
Fig. 2
Global burden of subcervical spinal cord injury across age groups: trends in incidence, prevalence, and YLDs. A Age-standardized rates. B Number of cases. Abbreviation: YLDs, years lived with disability
Fig. 3
Fig. 3
Global burden of cervical spinal cord injury by sex and overall population: Trends in incidence, prevalence, and YLDs. A Age-standardized rates. B Number of cases. Abbreviation: YLDs, years lived with disability
Fig. 4
Fig. 4
Sex-specific and overall burden of subcervical spinal cord injury globally: trends in incidence, prevalence, and YLDs. A Age-standardized rates. B Number of cases. Abbreviation: YLDs, years lived with disability
Fig. 5
Fig. 5
Socioeconomic gradients in the global burden of cervical spinal cord injury: Incidence, prevalence, and YLDs across SDI quintiles. A Age-standardized rates. B Number of cases. Abbreviation: SDI, socio-demographic index; YLDs, years lived with disability
Fig. 6
Fig. 6
Socioeconomic stratification of subcervical spinal cord injury burden: SDI-quintile trends in incidence, prevalence, and YLDs. A Age-standardized rates. B Number of cases. Abbreviation: SDI, socio-demographic index; YLDs, years lived with disability
Fig. 7
Fig. 7
Global distribution of age-standardized cervical spinal cord injury metrics (2021): A Incidence, B Prevalence, (C) YLDs. Abbreviation: YLDs, years lived with disability
Fig. 8
Fig. 8
Global distribution of age-standardized subcervical spinal cord injury metrics (2021): A Incidence, B Prevalence, (C) YLDs. Abbreviation: YLDs, years lived with disability
Fig. 9
Fig. 9
Projected global burden of cervical spinal cord injury (2020–2050): trends in (A) YLDs, (B) prevalence, and (C) incidence. Sex-stratified estimates are presented as bar plots with superimposed temporal trendlines. Abbreviation: YLDs, years lived with disability
Fig. 10
Fig. 10
Projected global burden of subcervical spinal cord injury (2020–2050): trends in (A) YLDs, (B) prevalence, and (C) incidence. Sex-stratified estimates are presented as bar plots with superimposed temporal trendlines. Abbreviation: YLDs, years lived with disability
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