The Influence of the COVID-19 Pandemic on Traumatic Spinal Cord Injury: A Six-Year Population-Based Retrospective Analysis

Study Design: Retrospective observational population-based study Objective Evaluate traumatic spinal cord injury (tSCI) epidemiology before, during, and after the coronavirus disease 2019 (COVID-19) pandemic in Texas Setting: Texas Department of State Health Services Trauma Database Methods The trauma database was queried for ICD-10 diagnosis codes pertinent to tSCI (S14, S24, S34, T093, and T91.3) from 2019 to 2024. Outcome measures included tSCI diagnosis, cause of injury, region of tSCI, age, sex, ethnicity, and public health region. A generalized estimating equations (GEE) model was utilized with a binomial distribution to evaluate predictors of injury status (tSCI vs. non-tSCI trauma). Data was evaluated in the pre-pandemic (2019), pandemic (2020-21) and post-pandemic (2022-24) period. Results A total of 7,901 tSCIs occurred over the study period. Compared with the pandemic period, the pre-pandemic year demonstrated a rate of 1,153 cases per year (OR = 1.96). This rate declined substantially during the pandemic (2020–2021) to 468.5 cases per year, followed by a marked rebound in the post-pandemic period (2022–2024) to 1,937 cases per year (OR = 3.08). Age, sex, ethnicity, injury mechanism, and Public Health Region were all independently associated with tSCI risk in multivariable GEE models. Conclusion SCI incidence declined during the COVID-19 pandemic, likely due to reduced exposure and healthcare avoidance, and subsequently rebounded markedly in the post-pandemic period, with disproportionate increases observed in Black and Asian groups and overall lower risk in non-PHR 3 regions. These changes in tSCI epidemiology provide critical insight into future research and healthcare priorities.