Brain and Spinal Cord Injuries Should Be Treated as Chronic Diseases, Experts Argue

For decades, medicine has treated traumatic brain injury and spinal cord injury as acute events: a patient arrives in the emergency department, receives emergency care, completes rehabilitation, and is discharged with the implicit message that the medical story is over. A new policy paper published in The Lancet Neurology argues that this framing is not only outdated but actively harmful. An international team of experts, led in part by researchers at the Mass General Brigham Neuroscience Institute, proposes that adult traumatic brain injury (TBI) and spinal cord injury (SCI) should be formally recognized as acute-onset, chronic multisystem disorders — conditions that launch biological, behavioral and social changes capable of persisting for years or even decades after the initial trauma. The paper, titled “Reframing traumatic brain injury and spinal cord injury as chronic multisystem disorders: toward integrated, long-term care,” lays out both the scientific rationale and a practical blueprint for overhauling how health systems deliver follow-up care to millions of survivors worldwide.

The case for reframing rests on a growing body of evidence that neurotrauma does not simply heal and fade. Survivors of TBI and SCI frequently develop cardiovascular, metabolic, endocrine, neurological, psychiatric and functional complications that can emerge or worsen long after acute treatment ends. The paper’s authors, including co-first author Sandro Marini, MD, and co-senior and corresponding author Saef Izzy, MD, both of the Mass General Brigham Neuroscience Institute, describe mechanisms such as chronic inflammation, accelerated biological aging and elevated cardiometabolic risk as hallmarks of the post-injury state. These are not incidental consequences but, in the authors’ framing, core features of a chronic disease process — comparable in kind, if not in origin, to the systemic changes seen after stroke or in diabetes.

Much of the quantitative foundation for this argument comes from a sustained research program at Mass General Brigham. Over the past seven years, studies led by Izzy, Marini and colleagues — including large cohort analyses published in JAMA Network Open in 2022, 2024, August 2025 and November 2025 — documented that survivors of traumatic brain and spinal cord injury face measurably higher rates of new cardiovascular, endocrine, neurological and psychiatric conditions compared with the general population. Those studies helped establish the size and breadth of the long-term risk. The new Lancet Neurology paper represents a deliberate next step: translating an accumulating evidence base into an actionable model of care that health systems, payers and policymakers can actually implement.

To build that blueprint, the authors conducted a structured synthesis of the recent literature. They searched multiple databases for English-language studies published between 2020 and 2026, prioritizing prospective analyses of long-term outcomes after TBI or SCI, and consulted international experts and stakeholders across disciplines. They then integrated this evidence with established chronic-care models — those developed for stroke, diabetes and cancer survivorship — to design a practical pathway for long-term neurotrauma care. The methodological choice is significant: rather than inventing a new care paradigm from scratch, the team adapted frameworks already proven in other chronic disease contexts, arguing that neurotrauma deserves the same continuity, coordination and surveillance those fields now take for granted.

What the evidence consistently shows, according to the authors, is a stark mismatch between the biology of neurotrauma and the structure of health care delivery. While the injury initiates persistent biological and psychosocial changes, most health systems continue to provide episodic support rather than coordinated long-term follow-up. Surveillance is often fragmented or absent once patients leave acute care and rehabilitation, meaning complications may go unrecognized until they trigger hospitalization, functional decline or other preventable harm. In other words, the window in which early intervention could prevent secondary conditions is frequently missed — not because effective measures do not exist, but because no one is systematically watching for the warning signs.

The proposed solution is a prevention-first care pathway built around several concrete components. The authors envision neurotrauma care navigators — dedicated points of contact who help survivors recognize early warning signs, understand the purpose of recommended screenings and take an active role in their own preventive health. The pathway also includes scheduled multisystem screenings targeting cardiovascular, endocrine, neurological and psychiatric risk, telehealth-enabled care to extend reach beyond specialty centers, and direct connections to specialized services. For patients and families, the central message is that recovery and medical risk do not end at discharge, and that structured follow-up with clear information about long-term risks could convert a period of silent vulnerability into one of managed prevention.

Recognizing that health systems differ enormously in resources, the framework is deliberately tiered. At its base sits a core package deliverable with limited resources: a minimum dataset, community health workers, mobile health tools and teleconsultation can provide a practical starting point in lower-resource settings. At the top tier, patients with complex needs receive intensive multidisciplinary care. The design philosophy is that every health system can begin with what it has, rather than waiting for ideal infrastructure. This tiering also addresses a persistent equity problem, since survivors in rural areas and low-income countries currently face the greatest barriers to any follow-up care at all.

Beyond the clinical pathway, the paper identifies seven priorities for implementation spanning three domains. On the health policy front, the authors call for formal recognition of chronic neurotrauma, payment reform to reimburse longitudinal care, and the creation of longitudinal registries to track outcomes at scale. In clinical care, they emphasize access to specialized rehabilitation and closer integration with existing services for stroke, memory disorders, psychiatric illness and epilepsy — specialties that already possess the tools to manage many post-neurotrauma complications. The third domain covers workforce development and equity, along with building the economic evidence base needed to sustain these changes. The inclusion of economic analysis reflects a pragmatic recognition that even compelling clinical evidence fails to change systems without a financial case.

The authorship itself signals the breadth of the effort. In addition to Marini and Izzy, Mass General Brigham authors include Joseph Giacino, and the broader author list spans specialists in neurosurgery, rehabilitation medicine, neuropsychology, epidemiology and policy from institutions worldwide, together with the Global Coalition for TBI as a Notifiable and Chronic Condition. The paper is framed as a Policy View rather than a primary research article, a format designed to influence clinical guidelines, payer decisions and public health policy. Funding disclosures note grant support to Izzy from the National Institutes of Health and the Department of War, and the published disclosure statement covers royalties and institutional support among co-authors.

The team’s agenda now moves from advocacy to validation. The next step, the authors report, is to characterize people living with TBI more precisely by combining longitudinal clinical information with multiomic data — genomic, proteomic and other molecular profiles measured over time. That work should clarify why some individuals develop particular long-term complications while others do not, and allow the identification of distinct risk profiles. Those profiles would then be used to tailor prevention more effectively and to prospectively test the care pathways and interventions proposed in the paper. If successful, the shift the authors envision would mark one of the more consequential reframings in modern neurotrauma care: treating the aftermath of a blow to the brain or spinal cord not as a closed chapter, but as the beginning of a chronic condition that medicine can monitor, anticipate and, increasingly, prevent.

Subject of Research: Long-term multisystem complications and integrated chronic care models after traumatic brain and spinal cord injury

Article Title: Research Spotlight: Working towards an integrated, long-term approach for traumatic brain and spinal cord injury

Article References: Research Spotlight: Working towards an integrated, long-term approach for traumatic brain and spinal cord injury. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: traumatic brain injury, spinal cord injury, chronic disease, neurotrauma, long-term care, cardiometabolic risk, care navigation, telehealth, health policy, rehabilitation, The Lancet Neurology, Mass General Brigham