We reviewed with great interest the article by Choi and colleagues regarding the incidence of acute spinal cord injury (SCI) and the associated complications of methylprednisolone use in a national population-based study in South Korea [1]. We consider this study to be valuable as it reported a 10-year incidence of acute SCI based on the data claimed in the national health insurance system. However, we would like to discuss several potential errors in the interpretation of the results, including the incidence and peak age of acute SCI in South Korea.

First, a sizable number of traumatic SCIs were excluded from the study sample. In South Korea, along with national health insurance, national workers’ compensation and automobile insurance have the status as the nation’s social security insurance and quasi-national insurance. National workers’ compensation also provides coverage to ~98% of the workers working in South Korea, similar to national health insurance, and automobile insurance is compulsory for all automobiles in Korea. As 2.29 million automobiles are in South Korea, there is currently one vehicle per 2.3 citizens [2, 3].

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