**1. Introduction**

Spinal cord injury (SCI) refers to the traumatic damage to the spinal cord and represents a harmful event that involves several repercussions on sensory and motor function that affects the quality of life (QoL) of patients (Furlan, Global incidence and prevalence of traumatic spinal cord injury) [1].

The most severe consequences of SCI are partial or complete loss of sensory function or motor control of arms, legs, and/or body, followed by the neurogenic bowel and bladder dysfunction, and other autonomic dysreflexia (AD) signs [1, 2].

In addition, if that was not enough, due to several comorbidities, patients have 1.29-fold increased risk of depression or anxiety [3].

#### **1.1 Epidemiology and public health**

SCI is a worldwide disease; prevalence is estimated in 1298 per million, while the global incidence varies depending on the geographical region, so it has been calculated between 8 and up to 246 cases per million per year [2, 4, 5].

In the last 30 years, these data have been increasing [6–8], and most frequent etiology is traumatic, representing 90% of cases [8]; vehicle accidents are the main cause [9], followed by injury due to falls in elderly population.

Males are most at risk, corresponding to the 80% of those affected, with a male to female ratio of 3.2:1 [4, 10] aged between 16 and 35 years [6, 11].

SCI represents a public health problem as it affects the working age population, with a mortality risk two to five times more likely to die prematurely than healthy people; several studies report a mortality rate during the first year after trauma of about 15% [12].

Also, this disease demands financial resources from patients, their families, and the government [13]. Annually, the economic waste associated to SCI in the United States amounts up to approximately 21.5 billion dollars, while in other health systems, such as Canada, an investment of up to 2.67 billion dollars is estimated, considering direct and indirect costs, which range from posttraumatic infections, medical consultations, caregiver services and rehabilitation, etc. [14].
