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Spinal cord injury (SCI) in elderly patients is increasingly common. The mechanism of trauma and patterns of SCI differ from those in younger patients. Additionally, the high prevalence of degenerative changes and stenosis in the elderly population may influence the clinical presentation and treatment patterns. Systemic medical issues and severity of neurological injury may contribute to the extremely high mortality rate in elderly patients. The elderly patients who survive SCI have the potential for meaningful functional and neurological recovery and require directed rehabilitation to this end.