Researchers from UHN’s KITE Research Institute (KITE), in collaboration with the Praxis Spinal Cord Institute, have found that, when all patients receive optimal care, biological sex does not significantly influence recovery after traumatic spinal cord injury. These findings reinforce the importance of ensuring equitable access to evidence-based treatment protocols to support consistent outcomes.
Traumatic spinal cord injury can lead to long-term disability and complex health care needs. Males are more likely to experience these injuries, often due to greater exposure to high-risk activities. However, biological differences between sexes, such as the influence of hormones, have raised questions about sex-based differences in recovery. Age-related hormonal changes, particularly in females, may also play a role in differences in recovery outcomes.
Previous studies have suggested that sex hormones, such as estrogen and progesterone, may help protect nerve cells and reduce inflammation, but clinical findings have been inconsistent.
To explore this further, a research team led by Dr. Julio Furlan, a KITE Scientist, analyzed health data from 1,968 individuals in a Canadian spinal cord injury registry (the Rick Hansen Spinal Cord Injury Registry). The study explored access to care and recovery outcomes between males and females, grouping participants by biological sex, age, and injury severity. Age categories were designed to reflect female hormonal stages: premenopausal (up to 40 years), perimenopausal (41–50 years), and postmenopausal (over 50 years).
The study found that males and females had comparable access to standard treatments, including rehabilitation services, specialized spine centres, and clinical assessments to measure neurological function and nerve recovery. Across all age groups, there were no significant differences in survival rates, neurological recovery, or the ability to regain independence.
Interestingly, females up to the age of 40 years were more likely to undergo surgical treatment than males with similar injury severity. While this did not lead to differences in recovery outcomes, further research is needed to understand whether non-clinical factors, such as unconscious bias, may influence treatment decisions.
Overall, the study highlights that when access to care is equitable, recovery outcomes are consistent across sexes. These findings support ongoing efforts to improve access to high-quality care and promote inclusive research that reflects the diversity of individuals affected by spinal cord injury.
Dr. Julio Furlan, Scientist at UHN’s KITE Research Institute, is the lead author of the study. Dr. Furlan is also an Associate Professor at the Department of Medicine at the University of Toronto.
This work was supported by the Praxis Spinal Cord Institute, with operational support provided by UHN Foundation to the KITE Research Institute.
Furlan JC, Shen T, Kurban D. Effects of Biological Sex on Access to Care and Outcomes After Acute Spinal Cord Injury: A Series of Propensity Score-Matched Cohort Studies. Neurology. 2025 Sep 9. doi: 10.1212/WNL.0000000000213996.