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Spinal Trauma in Mainland China From 2001 to 2007: An Epidemiological Study Based on a Nationwide Database

Liu, Peng MD*; Yao, Yuan MD, PhD; Liu, Ming-yong MD*; Fan, Wei-li MD*; Chao, Rui MD*; Wang, Zheng-guo PhD; Liu, Yun-cheng MM; Zhou, Ji-hong PhD; Zhao, Jian-hua PhD, MD*

doi: 10.1097/BRS.0b013e3182474d8b

Study Design. Descriptive epidemiological study.

Objective. To determine the epidemiological characteristics of spinal trauma in Mainland China.

Summary of Background Data. To date, a large-scale epidemiological analysis of spinal trauma in Mainland China has not been undertaken.

Methods. Data were acquired from Chinese Database of Traumas. Patients with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding of 805.x and 806.x (spinal column fracture with and without spinal cord injury) from 2001 to 2007 were identified. Variables assessed included patient demographics, etiology, segmental distribution, and outcomes.

Results. A total of 82,720 patients with spinal trauma were identified, accounting for 4.58% of all trauma patients in the study period. Spinal cord injuries (SCIs) and fracture-dislocations accounted for 16.87% and 7.17% of spinal trauma and 0.74% and 0.32% of all traumas in the same period, respectively. The male-to-female ratio was 2.33:1. About 79.32% of spinal trauma occurred in patients between 20 and 60 years of age. There was an annual increase in incidence during the study period. A total of 64,630 patients (78.13%) had a definitive cause, with motor vehicle accidents identified as the leading etiological factor (33.61%), followed by high falls (31.25%) and trivial falls (23.23%). Lumbar spine was most frequently involved (56.09%), followed by thoracic spine (23.77%), cervical spine (17.75%), and sacrococcygeal vertebrae (2.39%). Fracture-dislocation occurred most frequently in the cervical and lumbar spines, whereas spinal cord injury occurred most frequently in the cervical and thoracic spines. Children younger than 10 years of age were prone to cervical spine injury, whereas adults older than 60 years were more prone to osteoporotic thoracic and lumbar fractures. Overall rate of conservative treatment (55.88%) was higher than that of operative treatment (44.12%). Overall combined cure and improvement rates exceeded 90%. The male mortality rate was twice that of the female population. Lumbar spine injury was the most curable, whereas cervical spine injury was associated with the worst prognosis and the highest medical costs.

Conclusion. This is the first large-scale epidemiological study of spinal injury in Mainland China. The results obtained have important implications for future public health care planning, public safety, and resource allocation.

This descriptive epidemiological study of spinal trauma in Mainland China between 2001 and 2007 was based on a nationwide database containing 82,720 patients. Patient demography, etiology, segmental distribution of the spinal trauma, and outcomes are presented. Trauma-related factors and demographic characteristics were analyzed to direct future safety precautions and health care planning.

*Department of Spine Surgery, Daping Hospital, Third Military Medical University, Chongqing, China

Department 4, Institute of Surgery, Third Military Medical University, Chongqing, China

Medical Information Centre, General Logistics of PLA, Beijing, China.

Address correspondence and reprint requests to Jian-hua Zhao, PhD, MD, Daping Hospital, Institute of Surgery, No.10 Changjiangzhilu, Daping, Chongqing 400042, PR China; E-mail: or

Acknowledgment date: June 9, 2011. First revision date: August 21, 2011. Second revision date: December 9, 2011. Acceptance date: December 14, 2011.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Foundation funds were received to support this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.