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Help Prevent Spinal Cord Injury: ThinkFirst

hs3Rocco A. Armonda, MD, FAANS (left)
Chairman, ThinkFirst Board of Directors
Director of Neuroendovascular Surgery for MedStar Washington Hospital Center and MedStar Georgetown University Hospital
Washington, DC

Debby Gerhardstein RN, BSN, MA (middle)
Executive Director, ThinkFirst National Injury Prevention Foundation
Naperville, Illinois

Mark A Spatola, MD (right)
Past Chairman, ThinkFirst Board of Directors
Orange Park Neurosurgery
Orange Park, Florida

TF2Neurosurgeons are all too aware of the personal, family and societal impact of spinal cord injury (SCI). Loss of motor function, sensation, bowel and bladder function, increased morbidity, high medical costs, loss of income, and premature death are among the devastating effects. There is significant public interest and grief when superstars such as Ryan Shazier (Pittsburgh Steelers), Curtis Mayfield (R & B superstar), Christopher Reeve (Superman), or Amy van Dyken (Olympic swimmer) sustain an SCI. Unfortunately, too many individuals and their families must privately cope with this devastation each year. No focus on the issue of the spine is complete without touching on the prevention of SCI, and the ThinkFirst National Injury Prevention Foundation, established by neurosurgeons, is dedicated exclusively to efforts to eradicate needless harm to our patients, too often suffered in the prime of their lives.

The majority of spinal cord injuries are due to preventable trauma from motor vehicle crashes, acts of violence, falls, sports and recreation. There are roughly 17,500 new SCIs per year in the U.S., which do not include those who die at the scene of the incident.1 Males account for approximately 81 percent of SCIs, with the average age of injury currently 42 — a significant increase from age 29 in the 1970s.1  At risk for suffering SCIs are:

  • Individuals age 16-30 engaging in risky behavior;
  • Seniors over age 65 who are likely to fall; and
  • Those with bone and joint disorders. 2

kid helmetPhysicians and health care workers can help reduce the incidence of injury by raising awareness with patients, staff, colleagues and the public:

  • Ensure everyone is appropriately restrained when in a vehicle;
  • Secure infants and children in an approved car seat;
  • Don’t dive or jump into shallow water;
  • Wear a properly fitted, certified helmet while bicycling and other at-risk sports;
  • Do not wear earbuds when driving, biking or walking on roadways;
  • Wear protective sports gear and avoid unnecessary force with contact sports;
  • Never drive, bike, swim or dive under the influence of drugs or alcohol;
  • Reduce distractions by putting your phone away while driving;
  • Don’t drive or operate machinery while fatigued or distracted; and
  • Keep homes free of hazards that could contribute to adult falls or childhood injuries.

spineThinkFirst’s mission is to prevent brain, spinal cord and other traumatic injury through education, research and advocacy, with a focus on providing educational community outreach programs for hospital and educator use. Founded by the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) in 1986, the Foundation is an independent 501c3 nonprofit organization supported by donations, sponsorships and grants. Hospitals and other medical facilities apply for training to develop ThinkFirst chapters and effectively use ThinkFirst programs. There are currently 140 U.S. chapters providing more than 7,000 presentations to at least 500,000 people annually. There are also 36 international chapters, soon to be bolstered by world-wide promotion through the newly-formed World Federation of Neurosurgical Societies (WFNS) Task Force on Neurotrauma Prevention, led by Chair Tariq Khan, MD, FRCS and ThinkFirst International chair, Gail L. Rosseau, MD, FAANS.

Over the years, ThinkFirst has developed programs for all ages. Each program includes video, slides, handouts and evaluation tools. Training is provided for nurses, health educators, physicians and VIP Speakers — Voices for Injury Prevention — who, during presentations, poignantly share their own personal experience with SCI. Programs include:

  • ThinkFirst For Kids — an animated program for grades 1-3;
  • ThinkFirst For Youth — grades 4-8;
  • ThinkFirst For Teens — high school and college;
  • ThinkFirst About Concussion — youth, teens and parents;
  • ThinkFirst To Prevent Falls — older adults;
  • ThinkFirst For Your Baby — new and expectant parents; and
  • ThinkFirst First Impact — parents of teen drivers (currently being piloted in Missouri).

We know that these efforts have an impact! For a review of past ThinkFirst studies, please read this Neurosurgery article, “Comprehensive Review of the ThinkFirst Injury Prevention Programs: A 30-Year Success Story for Organized Neurosurgery.”

Expanding our programs to even more schools and community groups requires neurosurgeons and others to help. To see how you can take part, visit ThinkFirst to:

  • Start or assist a chapter;
  • Present programs with your chapter;
  • Attend ThinkFirst conferences and events;
  • Join a ThinkFirst committee (Resource Development, Program Advisory, Marketing/PR, Efficacy or International); and
  • Promote improved safety legislation, such as restricting cell phone use while driving, requiring helmets for sports and motorcycles, and other protective measures.

As neurosurgeons, we must strive to provide better treatment for spinal cord injuries and disorders, but we can all agree that preventing traumatic injury will always be better than any treatment.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #SpineMonth.


  1. National Spinal Cord Injury Statistical Center, Facts and Figures at a Glance. Birmingham, AL: University of Alabama at Birmingham, 2017. (
  2. ThinkFirst National Injury Prevention Foundation, Spinal Cord Injury Fast Facts. (

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