The Italian Spinal Cord Injury Landscape in a Global Context: Military Personnel and Veterans in Focus — The VERTICAL Report

Spinal cord injury (SCI) represents a major cause of long-term disability worldwide, with substantial clinical, socioeconomic, and healthcare implications. However, epidemiological evidence remains fragmented, particularly regarding SCI occurring in military personnel, veterans, and armed conflict settings. This report aims to contextualize the Italian SCI landscape within global epidemiological trends, with a specific focus on military- and veteran-related injuries, their clinical characteristics, long-term consequences, and associated socioeconomic burden. Given the substantial heterogeneity of the available evidence in terms of study populations, injury definitions, epidemiological measures, study designs, and reporting frameworks, a quantitative meta-analysis was considered methodologically inappropriate. Furthermore, the limited availability of military- and veteran-specific data, particularly in Italy, precluded a comprehensive quantitative synthesis. Therefore, a structured narrative review approach was adopted to integrate epidemiological, clinical, institutional, and socioeconomic evidence, critically examine the available literature, and identify relevant knowledge gaps. The report highlights the challenges of comparing SCI epidemiological estimates across different geographical, clinical, and military contexts, while emphasizing the distinctive characteristics of conflict-related injuries and the complexity of their long-term healthcare and social implications. In the Italian context, the available evidence reveals important limitations in the identification and characterization of SCI among military personnel and veterans, reflecting the fragmentation of information across existing clinical, epidemiological, administrative, and institutional sources. By integrating the available evidence, the VERTICAL Report provides a comprehensive framework for understanding SCI in military and civilian contexts and identifies opportunities for improved data integration, epidemiological surveillance, interdisciplinary research, and evidence-informed healthcare planning.