Objectives: To observe the trends in vital capacity (VC) over time in tetraplegics 20 years and more after injury, the e ects of age at injury, severity of injury and gender on this trend. Methods: The medical records of all spinal cord injured persons admitted to a regional spinal injury center from January 1960 to December 1996 were reviewed. Fifty-seven patients had documented post-rehabilitation VC (mean 1.3+1.1 years) and VC at 10 (mean 11.8+2.69) and 20 (20.60+2.67) years post injury and beyond. Results: The mean age at injury was 23.2+9.1 years. Severity of injury when classi®ed according the system proposed by Coll et al were: Group 1: C1 ± 4 Frankel A injury: 11.6%, Group 2: C5 ± 8 Frankel A injury: 55.6%, Group 3: C2 ± 8 Frankel B and C: 29.8% and Group 4: C2 ± 8 Frankel D: 3.5% respectively. The mean VC at initial, 10 and 20 years post injury was 2586+948, 2803+940 and 2525+818 cc respectively. Multivariate analysis of variance revealed that there was signi®cant di erence in VC over a 20 year period, (F(2,54)=8.43, P50.05). The di erence between VC at 10 years and VC at 20 years accounted for the 19.8% of the variance in VC over time (F(1,55)=12.35, P50.05). Age at injury, gender and severity of injury did not have a signi®cant in¯uence on the rate of decline in VC. Analysis of a subset of 26 patients who were followed up more than 20 years post injury (range 22 to 34.5 years) revealed similar,

Physiologically complete cervical spinal cord transection results in motor and sensory quadriplegia and interruption of the sympathetic neural pathways; this condition leads to metabolic deficiencies suggestive of abnormal endocrine function. An investigation of the non-stimulated secretion of some of the hormones influencing metabolism was undertaken by evaluating thyroxine, iodothyronine binding index, testosterone, growth hormone, calcitonin, and parathyroid hormone in venous blood of fasting healthy subjects and quadriplegic patients. The effect of the duration of the paralysis was examined by repeating the evaluations at different periods after onset. The results show that 1) thyroxine was low for 2 months after onset in 21 patients and normal thereafter in 53 patients, 2) testosterone was low throughout the study in 62 patients; the decrease is greatest during the first 2 months, 3) growth hormone was often increased in 46 patients for 8 months after onset, and nearly normal afterward in 25 patients, 4) calcitonin was normal in 22 patients throughout the study, and 5) parathyroid hormone was normal in relation to normal serum calcium as early as 6 days after onset in 79 out of 83 patients. These data do not preclude a parathyroid hormone increase at onset or alterations in the patterns of circadian secretion and in the responses to specific stimulation for the hormones evaluated. Therefore, it may be concluded only that the steady state secretion of these hormones is not altered by traumatic quadriplegia per se, but is temporarily modified by the original insult to the nervous system, and by changes in life pattern and the heavy sedation that follows. The results suggest that the minor endocrin changes occurring in quadriplegic patients during the early period of paralysis will be rapidly overcome by rehabilitation to an active life pattern.