OBJECTIVE To assess the temporal trends in the incidence and demographic characteristics of traumatic spinal cord injury (TSCI) with clinical concomitant traumatic brain injury (TBI), in an unselected, geographically defined cohort, 1952-2001. MATERIAL AND METHODS The patients were identified from hospital records. TBI was classified as none, mild, moderate, and severe. RESULTS Of 336 patients, 157 (46.7%) patients had a clinical concomitant TBI. Clinical TBI was classified as mild in 30.1%, moderate in 11.0% and severe in 5.7%. The average annual incidence increased from 3.3 per million in the first decade to 10.7 per million in the last. Alcohol was the strongest risk factor of clinical TBI (OR = 3.69) followed by completeness of TSCI (OR = 2.18). CONCLUSIONS The incidence of TSCI with concomitant TBI has increased during the last 50 years. Alcohol and completeness of injury are strong risk factors. Increased awareness of dual diagnoses is necessary.