Evolving Global Burden of GBD-Defined Spinal Cord Lesions, 2014-2023: A Global Burden of Disease Analysis of the Geriatric Transition and Anatomical Distribution.

Background: Global Burden of Disease (GBD)-defined spinal cord lesion categories are major contributors to global disability. However, contemporary analyses focusing on age-specific disability burden, socio-demographic variation, and anatomical distribution remain limited. This study aimed to analyze global and regional trends in prevalence and disability burden associated with GBD-defined spinal cord lesions from 2014 to 2023, with particular emphasis on working-age adults aged 15-49 years, older adults aged ≥70 years, Socio-demographic Index (SDI) regions, and anatomical level. Methods: We performed a secondary analysis of Global Burden of Disease (GBD) 2023 Injuries by Nature data, extracting estimates for "spinal cord lesion at neck level" and "spinal cord lesion below neck level." Global and regional prevalence and Years Lived with Disability (YLDs) were extracted. The cervical ratio was calculated as the proportion of total YLDs attributable to neck-level lesions. Temporal trends were assessed using log-linear regression and annual percent change (APC). Results: Between 2014 and 2023, the global age-standardized prevalence rate decreased from 363.17 to 318.28 per 100,000 population, corresponding to a 12.4% reduction (APC -1.97%/year; p = 0.002). The global age-standardized YLD rate decreased by 14.0% (APC -2.19%/year; p = 0.001). Absolute prevalence remained relatively stable, increasing slightly from 27.31 million to 27.54 million, while absolute YLDs changed from 8.16 million to 8.02 million without a significant linear trend. A clear age-related divergence was observed: YLDs increased by 31.5% among adults aged ≥70 years (APC +2.57%/year; p < 0.001), while they decreased by 11.7% among individuals aged 15-49 years (APC -1.87%/year; p = 0.005). Cervical-level lesions accounted for 63.5% of global YLDs in 2023, and the cervical ratio increased stepwise from low-SDI to high-SDI regions. Conclusions: Although age-standardized prevalence and YLD rates associated with GBD-defined spinal cord lesions declined globally, the absolute burden remained relatively stable and shifted toward older adults. These findings highlight the importance of considering age structure, socio-demographic development, and anatomical distribution when planning rehabilitation, long-term care, and health-system resources for populations affected by GBD-defined spinal cord lesions.