Supervisors: professor Toomas Asser (TÜ närvikliinik)
dotsent Janika Kõrv (TÜ närvikliinik)
dr Tiina Rekand (Haukelandi Ülikoolihaigla, Norra)
Opponent: professor Jean-Jacques Wyndaele, MD, PhD (University Antwerp and Antwerp University Hospital, Belgia)
Traumatic spinal cord injury (TSCI) is either a direct or an indirect damage to the nerve cells in the spinal cord. According to the height of the lesion, the clinical picture is variable. Injury to the spinal cord in the cervical region is associated with loss of muscle strenght and/or sensibility in all four extremities. Injury to the lower spinal cord causes loss of strenght and/or sensibility only in legs. Every year more than 100,000 people acquire TSCI around the world. The reported incidence is the highest in the United States and the lowest in the Netherlands. The incidence of TSCI is 39.7 per million population in Estonia, which means that almost 50 individuals sustain TSCI every year in Estonia. The incidence is unfortunately one of the highest in Europe. The rates are significantly higher for men compared with women and especially among the youngest men (age-group 16 to 30 years). The leading cause of TSCI are falls, followed by motor vehicle accidents and diving. A significant proportion of injuries are related to alcohol consumption before trauma in Estonia. As the time passes, the accelerated aging is taking place in those with TSCI. This is particulary evident in musculoskeletal, endocrine, and cardiovascular systems. Life expectancy is significantly decreased in TSCI patients in Estonia compared with the general population. During the first year, the leading underlying causes of death were external causes of injury, cardiovascular diseases and different infections. Later, the cardiovascular diseases became predominant, followed by suicides. TSCI does not affect the brain, although changes in brain function have been identified by different studies. Our study found broadening of cortical activation and a shift of the centre of gravity during the first year after TSCI depending on the recovery. These results show that during the first post-TSCI year, compensatory changes of brain function will take place. We suggest that the results offer unique evidence for the usefulness of functional magnetic resonance imaging as a predictor for outcome after TSCI. As there is no cure for TSCI today, prevention is very important.