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BACKGROUND

Spinal cord injury (SCI), or traumatic myelopathy, was first described around 2500 BC by ancient Egyptians, as written in the ancient Egyptian medical text the Edwin Smith Surgical Papyrus. The textbook referenced six cases of spinal canal injury, with one case referencing paralysis of the extremities, bladder incontinence, abdominal distention, and priapism.14 Subsequently, Hippocrates is often credited with first describing traction for the reduction of spinal fractures with resultant spinal cord injuries, as well as describing chronic paralysis, constipation, bladder difficulty, venous stasis, and pressure injury resulting from spinal injury.1,2,4 Despite a long history of knowledge, most patients with SCIs died within a few weeks, usually from urosepsis, prior to the 1940s.2 It wasn't until the end of World War II that management began to be standardized. SCI patients were treated in specialized units with multidisciplinary programs dedicated to treatment and rehabilitation of paralysis.2,4 Sir Ludwig Guttman of the United Kingdom and Dr. Donald Munro of Boston, Massachusetts, developed early standardizations of care in the United Kingdom and the United States, respectively.1,3 By the late 1940s, the average life expectancy increased to approximately 10 years and doubled to 20 years in the 1950s; this improvement was attributed to the use of antibiotics and multidisciplinary programs.2

In 1971, Dr. John Young obtained a federal grant to study these programs in order to demonstrate that multidisciplinary programs provided better health outcomes compared to fragmented care for SCI patients in Phoenix, Arizona. He called his system of comprehensive care a “Model System.”1,5,6 The Model System incorporates five components: development of an effective emergency medical services system, acute care, physical rehabilitation, psychosocial and vocational services, and a follow-up program.5 Since its inception, the Model System program expanded to more locations around the United States. Currently there are 14 centers sponsored by the National Institute on Disability and Rehabilitation Research collectively housing the largest database of traumatic SCI information.1,57 The U.S. Department of Veterans Affairs (VA) has its own system of care and is the largest single network of comprehensive SCI care in the United States. The VA system is composed of a hub and spoke system with 24 regional centers and 134 primary care teams serving as spokes.8

Advancements in medical care, technology, and acute surgical interventions have changed the standardization of medical practice and delivery of medical services contributing to the decrease in morbidity and mortality following SCI. Specialized medical training is needed to treat patients with SCI as well as the continuation of development of comprehensive treatment centers. The subspecialty of SCI medicine addresses prevention, diagnosis, treatment, and management of both nontraumatic and traumatic etiologies of SCI through an interdisciplinary approach.9 The American Board of Physical Medicine and Rehabilitation (ABPMR) offers subspecialty certification in SCI medicine whereby to ...

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