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

## TL;DR

This study reports on the incidence and causes of traumatic and non-traumatic spinal cord injuries in Salzburg, Austria, finding that non-traumatic injuries make up the majority.

## Contribution

The first comprehensive report on non-traumatic spinal cord injury incidence in Austria, revealing it constitutes 83% of all SCIs.

## Key findings

- Non-traumatic spinal cord injuries accounted for 83.2% of all cases identified in Salzburg from 2013 to 2023.
- Falls were the leading cause of traumatic SCI, while multiple sclerosis was the most frequent non-traumatic cause.
- SCI incidence in Salzburg was higher than previous Austrian estimates due to inclusion of non-traumatic cases.

## Abstract

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.

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.

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.

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.