The outlook for people with chronic spinal cord injury (SCI) is linked directly to the severity of the neurologic injury, and associated impairment. If the neurologic deficit is progressive, surgical intervention may be required to achieve damage control. This can lead to some improvement in neurologic status. With established lesions, full recovery of neurologic function is unlikely, and the outcome depends on the residual function and the ability of rehabilitation to maximize it.
SCI is associated with significant challenges to overall wellbeing, including a risk of mental health problems, a high risk of secondary chronic illnesses, financial insecurity, and social isolation. One review showed that poor social participation can lead to problems in reintegration into society following discharge from inpatient rehabilitation.[136]Craig A, Nicholson Perry K, Guest R, et al. Adjustment following chronic spinal cord injury: determining factors that contribute to social participation. Br J Health Psychol. 2015 Nov;20(4):807-23.
http://www.ncbi.nlm.nih.gov/pubmed/26037456?tool=bestpractice.com
Several factors predicted poor social participation: older age when injured, medical complications, cognitive deficits, poor perceptions of control or self-efficacy, and poor social support.[136]Craig A, Nicholson Perry K, Guest R, et al. Adjustment following chronic spinal cord injury: determining factors that contribute to social participation. Br J Health Psychol. 2015 Nov;20(4):807-23.
http://www.ncbi.nlm.nih.gov/pubmed/26037456?tool=bestpractice.com
Social support may lead to better health and functioning in people with SCI.[137]Müller R, Peter C, Cieza A, et al. The role of social support and social skills in people with spinal cord injury: a systematic review of the literature. Spinal Cord. 2012 Feb;50(2):94-106.
http://www.ncbi.nlm.nih.gov/pubmed/22006079?tool=bestpractice.com
Return to work is higher in patients who were injured younger, with less severe injuries, and with higher functional independence, although employment rates are low after SCI.[138]Lidal IB, Huynh TK, Biering-Sørensen F. Return to work following spinal cord injury: a review. Disabil Rehabil. 2007 Sep 15;29(17):1341-75.
http://www.ncbi.nlm.nih.gov/pubmed/17729082?tool=bestpractice.com
Patients with SCI have a decreased life expectancy compared with the general population.[139]National Spinal Cord Injury Statistical Centre. The 2013 annual statistical report for the spinal cord injury model systems. 2013 [internet publication].
https://www.nscisc.uab.edu/PublicDocuments/reports/pdf/2013%20NSCISC%20Annual%20Statistical%20Report%20Complete%20Public%20Version.pdf
[140]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 Sep;17(1 Suppl):11-26.
http://www.ncbi.nlm.nih.gov/pubmed/22985366?tool=bestpractice.com