Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Traumatic spinal cord injury in Italy 20 years later: current epidemiological trend and early predictors of rehabilitation outcome


Study design

Multicenter prospective observational study of people with acute traumatic spinal cord injury (TSCI) admitted to rehabilitation.


To update epidemiological characteristics of a TSCI Italian population and verify the impact of patient characteristics at admission on two outcomes: functional gain (SCIM III) and discharge destination.


Thirty-one SCI centers for comprehensive rehabilitation in 13 Italian regions.


All consecutive individuals admitted with acute TSCI were enrolled from October 1, 2013 to September 30, 2014; data were recorded on rehabilitation admission and discharge. Functional gain and discharge destination were identified as outcome measures and statistically analyzed with patient characteristics at admission to identify early outcome predictors.


Five hundred and ten individuals with TSCI met inclusion criteria; falls represented the most frequent etiology (45%). On admission, AIS A-B-C tetraplegia was reported in 35% of cases; AIS A-B-C paraplegia in 40%; AIS D paraplegia/tetraplegia in 25%. The majority were discharged home (72%). The mean (SD) SCIM gain was 38 ± 26 points. A predictive model was found for discharge setting: individuals with fall-related injuries, severe SCI (AIS A-B-C tetraplegia), tracheal cannula or indwelling catheter on admission, were less likely to be discharged home (OR 95% CI 0.15 [0.06, 0.35]). A model with a lower predictive power was found for SCIM gain, with lower score expected for females, older age, higher severity of SCI, a longer onset of injury admission interval (OAI), and mechanical ventilation on admission.


Prognostic factors in early rehabilitation are still hard to identify, making it difficult to correctly approach customized rehabilitation.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3

Data availability

Data are included in the registry of 2012 CCM project according to national privacy regulations and are available by a formal request to the Emilia-Romagna Regional Health Authority.


  1. 1.

    Richard-Denis A, Beausejour M, Thompson C, Nguyen BH, Mac-Thiong JM. Early predictors of global functional outcome after traumatic spinal cord injury: a systematic review. J Neurotrauma. 2018;35:1–21.

    Article  Google Scholar 

  2. 2.

    Wilson JR, Cadotte DW, Fehlings MG. Clinical predictors of neurological outcome, functional status, and survival after traumatic spinal cord injury: a systematic review. J Neurosurg Spine. 2012;17:11–26.

    Article  Google Scholar 

  3. 3.

    Aidinoff E, Front L, Itzkovich M, Bluvshtein V, Gelernter I, Hart J, et al. Expected spinal cord independence measure, third version, scores for various neurological levels after complete spinal cord lesions. Spinal Cord. 2011;49:893–6.

    CAS  Article  Google Scholar 

  4. 4.

    World Health Organization, International Spinal Cord Society. International perspectives on spinal cord injury. Geneve: World Health Organization; 2013. pp. 73–8.

  5. 5.

    Cheng CL, Plashkes T, Shen T, Fallah N, Humphreys S, O’Connell C, et al. Does specialized inpatient rehabilitation affect whether or not people with traumatic spinal cord injury return home? J Neurotrauma. 2017;34:2867–76.

    Article  Google Scholar 

  6. 6.

    New PW. Prospective study of barriers to discharge from a spinal cord injury rehabilitation unit. Spinal Cord. 2015;53:358–62.

    CAS  Article  Google Scholar 

  7. 7.

    AlHuthaifi F, Krzak J, Hanke T, Vogel LC. Predictors of functional outcomes in adults with traumatic spinal cord injury following inpatient rehabilitation: a systematic review. J Spinal Cord Med. 2017;40:282–94.

    Article  Google Scholar 

  8. 8.

    Fromovich-Amit Y, Biering-Sørensen F, Baskov V, Juocevicius A, Hansen HV, Gelernter I, et al. Properties and outcomes of spinal rehabilitation units in four countries. Spinal Cord. 2009;47:597–603.

    CAS  Article  Google Scholar 

  9. 9.

    Ackerman P, Morrison SA, McDowell S, Vazquez L. Using the spinal cord independence measure III to measure functional recovery in a post-acute spinal cord injury program. Spinal Cord. 2010;48:380–7.

    CAS  Article  Google Scholar 

  10. 10.

    Abdul-Sattar AB. Predictors of functional outcome in patients with traumatic spinal cord injury after inpatient rehabilitation in Saudi Arabia. Neurorehabilitation. 2014;35:341–7.

    Article  Google Scholar 

  11. 11.

    Facchinello Y, Beausejour M, Richard-Denis A, Thompson C, Mac-Thiong JM. The use of regression tree analysis for predicting the functional outcome following traumatic spinal cord injury. J Neurotrauma. 2017.

  12. 12.

    Wilson JR, Davis AM, Kulkarni AV, Kiss A, Frankowski RF, Grossman RG, et al. Defining age-related differences in outcome after traumatic spinal cord injury: analysis of a combined, multicenter dataset. Spine J. 2014;14:1192–8.

    Article  Google Scholar 

  13. 13.

    Furlan JC, Hitzig SL, Craven BC. The influence of age on functional recovery of adults with spinal cord injury or disease after inpatient rehabilitative care: a pilot study. Aging Clin Exp Res. 2013;25:463–71.

    Article  Google Scholar 

  14. 14.

    Kaminski L, Cordemans V, Cernat E, Bra Ki M, Mac-Thipong JM. Functional outcome prediction after traumatic spinal cord injury based on acute clinical factors. J Neurotrauma. 2017;34:2027–33.

  15. 15.

    Wilson JR, Grossman RG, Frankowski RF, Kiss A, Davis AM, Kulkarni AV, et al. A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors. J Neurotrauma. 2012;29:2263–71.

    Article  Google Scholar 

  16. 16.

    Craven BC, Kurban D, Farahani F, Rivers CS, Ho C, Linassi G, et al. Predicting rehabilitation length of stay in Canada: it’s not just about impairment. J Spinal Cord Med. 2017;40:676–86.

    Article  Google Scholar 

  17. 17.

    Pagliacci MC, Celani MG, Zampolini M, Spizzichino L, Franceschini M, Baratta S, et al. An Italian survey of traumatic spinal cord injury. The Gruppo Italiano Studio Epidemiologico Mielolesioni study. Arch Phys Med Rehabil. 2003;84:1266–75.

    Article  Google Scholar 

  18. 18.

    DeVivo MJ. Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal Cord. 2012;50:365–72.

    CAS  Article  Google Scholar 

  19. 19.

    Selvarajah S, Hammond ER, Haider AH, Abularrage CJ, Becker D, Dhiman N, et al. The burden of acute traumatic spinal cord injury among adults in the United States: an update. J Neurotrauma. 2014;31:228–38.

    Article  Google Scholar 

  20. 20.

    Pérez K, Novoa AM, Santamariña-Rubio E, Narvaez Y, Arrufat V, Borrell C, et al. Incidence trends of traumatic spinal cord injury and traumatic brain injury in Spain, 2000-9. Accid Anal Prev. 2012;46:37–44.

    Article  Google Scholar 

  21. 21.

    Ferro S, Cecconi L, Bonavita J, Pagliacci MC, Biggeri A, Franceschini M. Incidence of traumatic spinal cord injury in Italy during 2013-4: a population-based study. Spinal Cord. 2017;55:1103–7.

    CAS  Article  Google Scholar 

  22. 22.

    Biering-Sørensen F, DeVivo MJ, Charlifue S, Chen Y, New PW, Noonan V, et al. International Spinal Cord Injury Core Data Set (version 2.0)-including standardization of reporting. Spinal Cord. 2017;55:759–64.

    Article  Google Scholar 

  23. 23.

    Kirshblum SC, Burns SP, Biering-Sørensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury. J Spinal Cord Med. 2011;34:535–46.

    Article  Google Scholar 

  24. 24.

    DeVivo MJ, Biering-Sørensen F, New P, Chen Y. Standardization of data analysis and reporting of results from the International Spinal Cord Injury Core Data Set. Spinal Cord. 2011;49:596–9.

    CAS  Article  Google Scholar 

  25. 25.

    Zhang Z. Variable selection with stepwise and best subset approaches. Ann Transl Med. 2016;4:136.

    Article  Google Scholar 

  26. 26.

    Lee BB, Cripps R, New P, Fitzharris M, Noonan V, Hagen EM, et al. Demographic profile of spinal cord injury. In: Chhabra HS, editor. ISCoS textbook on comprehensive management of spinal cord injuries. New Delhi: Wolters Kluwer; 2015. pp. 36–52.

  27. 27.

    Shibahashi K, Nishida M, Okura Y, Hamabe Y. Epidemiological state, predictors of early mortality, and predictive models for traumatic spinal cord injury: a multicenter nationwide cohort study. Spine. 2019;44:479–87.

    Article  Google Scholar 

  28. 28.

    Pagliacci MC, Celani MG, Spizzichino L, Zampolini M, Aito S, Citterio A, et al. Spinal cord lesion management in Italy: a 2-year survey. Spinal Cord. 2003;41:620–8.

    CAS  Article  Google Scholar 

  29. 29.

    National Spinal Cord Injury Statistical Center (NSCISC). 2018 Annual Report. Complete Public Version. Birmingham, AL: University of Alabama; 2018.

  30. 30.

    Fromovich-Amit Y, Biering-Sørensen F, Baskov V, Juocevicius A, Hansen HV, Gelernter I, et al. Properties and outcomes of spinal rehabilitation units in four countries. Spinal Cord. 2009;47:597–603.

    CAS  Article  Google Scholar 

Download references


CCM is the National Center for Diseases prevention and Control whose task is to liaise with the Ministry of Health and the regional governments as far as surveillance and prevention are concerned and whose aim is to promptly respond to emergencies.

Collaborating Hospitals and Regional Health Authorities

M.V. Actis, M. Stillittano (Città della Salute e della Scienza Hospital, Turin); S. Petrozzino (Alessandria Hospital); C. Cisari (Novara Hospital), M. Salvini (Piedmont Region); T. Redaelli, R. Tosi (Niguarda Hospital, Milano); C.M. Borghi, A. Bava (Pini CTO Hospital, Milano); C. Pistarini, (IRCCS Maugeri Foundation, Pavia); G. Molinero, A. Signorelli (Bergamo Hospital); S. Sandri (Legnano- Magenta Hospital); F. Simeoni (Garbagnate Hospital); M. Brambilla (Valtellina Hospital) M.A. Banchero, A. Olivero, G. Zanaboni (Lombardy Region); R. Avesani (Don Calabria Hospital, Negrar, Verona); G. Bertagnoni, M. Leucci, L. Lain (S. Bortolo Hospital, Vicenza); M. Saia (Veneto Region); A. Zampa (Gervasutta Hospital, Udine); P. Del Fabro (Udine Hospital); M. Saccavini (Palmanova Hospital, Udine); A. Fanzutto (Friuli Venezia Giulia Region); A. Massone (Santa Corona Hospital, Pietra Ligure, Savona); J. Bonavita, D. Gaddoni, S. Olivi, G. Musumeci, R. Pederzini (Montecatone Rehabilitation Institute, Imola, Bologna); H. Cerrel Bazo, D. Nicolotti, (Villanova d’Arda Hospital, Piacenza); M. Nora, R. Brianti, C. Iaccarino, A. Volpi (Parma Hospital); A. Lombardi, S. Cavazza, F. Casoni (Baggiovara Hospital, Modena); F. De Iure, G. Gordini, R. Piperno (Maggiore Hospital, Bologna); G. Teodorani, A. Naldi, G. Vergoni, (Cesena Hospital); E. Maietti, A. Botti (Ferrara Hospital); S. Ferro, G. Pagoto (Emilia-Romagna Region); G. Del Popolo, M. Moresi, M. Postiglione, C. Bini (Careggi Hospital, Firenze); M. Tagliaferri (Tuscany Region); M. A. Recchioni, P. Pelaia (Ospedali Riuniti, Ancona); L. Di Furia (Marche Region); M.C. Pagliacci, R. Maschke, L. Caruso, L. Speziali (Perugia Hospital); M. Zenzeri (Umbria Region); P. Fiore, R. Marvulli (Bari Hospital); R. Nardulli (IRCCS Maugeri Foundation, Cassano Murge, Bari); C. Lanzillotti (IRCCS Maugeri Foundation, Ceglie Messapica, Brindisi); M. Ruccia (Puglia Region); M.P. Onesta, T. Di Gregorio (Cannizzaro Hospital, Catania); F. Franchina (Villa Sofia Hospital, Palermo); M.G. Furnari (Sicily Region); C. Pilati, M. Merafina, F. Crescia (Alesini CTO Hospital, Rome); D. Fletzer (Ostia Hospital, Rome); G. Scivoletto (IRCCS S. Lucia Foundation, Rome); N. Di Lallo (Lazio Region).


This study was financed within the framework of the 2012 CCM program.

Author information





MF participated in the scientific coordination of the project and contributed to writing the report. JB coordinated data collection and contributed to writing the report. LC conducted the statistical analyses and contributed to writing the report. SF coordinated all scientific aspects of the research project. MCP coordinated data collection and contributed to writing the report.

Corresponding author

Correspondence to Jacopo Bonavita.

Ethics declarations

Ethics statement

We certify that all applicable institutional and governmental regulations concerning the ethical use of data originally collected for clinical purpose were followed during the course of this research.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Franceschini, M., Bonavita, J., Cecconi, L. et al. Traumatic spinal cord injury in Italy 20 years later: current epidemiological trend and early predictors of rehabilitation outcome. Spinal Cord 58, 768–777 (2020).

Download citation

Further reading


Quick links