Cervical Spinal Cord Injury and the Need for Cardiovascular Intervention

Bilello, John F.; Davis, James W.; Cunningham, Mark A.; Groom, Tammi; Lemaster, Debbie; Sue, Lawrence P.

doi:10.1001/archsurg.138.10.1127

Cited by 105 publications

(62 citation statements)

References 19 publications

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“…Cardiovascular complications in the early stages of high SCI can be life-threatening, and include profound hypotension, bradyarrhythmias and cardiac arrest. 3 There is also alarming recent evidence demonstrating an increased risk of ischemic stroke after SCI. 4 Although some of these complications can improve in the weeks following SCI, cardiovascular control rarely returns to pre-injury baseline.…”

Section: Introductionmentioning

confidence: 99%

Peripheral vascular function in spinal cord injury: a systematic review

et al. 2012

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Background: During the past 20 years, significant advances in patient care have resulted in individuals with spinal cord injury (SCI) living longer than before. As lifespan increases, cardiovascular complications are emerging as the leading cause of mortality in this population, and individuals with SCI develop cardiovascular disease at younger ages than their able-bodied counterparts. To address this increasing clinical challenge, several recent studies investigated the central cardiovascular adaptations that occur following SCI. However, a somewhat less recognized component of cardiovascular dysfunction in this population is the peripheral vascular adaptations that also occur as a result of SCI. Study design: Literature review.Objective: To present a comprehensive overview of changes in arterial structure and function, which occur after SCI. Setting: Canada. Methods: A systematic literature review was conducted to extract studies that incorporated measures of arterial structure or function after SCI in animals or humans. Results: Individuals with SCI exhibit vascular dysfunction below the lesion that is characterized by a reduction in conduit artery diameter and blood flow, increased shear rate and leg vascular resistance, and adrenoceptor hyper-responsiveness. There is also recent alarming evidence for central arterial stiffening in individuals with SCI. Conclusion: Although physical deconditioning is the primary candidate responsible for the maladaptive remodeling of the peripheral vasculature after SCI, there is emerging evidence that blood pressure oscillations, such as those occurring in the large majority of individuals with SCI, also exacerbates vascular dysfunction in this population.

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Section: Introductionmentioning

confidence: 99%

Peripheral vascular function in spinal cord injury: a systematic review

et al. 2012

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“…1 Bradycardia is almost universal, and a cardiac arrest occurs in up to 15% of such patients. 2,3 Typically, the frequency and severity of bradycardia are directly related to the severity of the cervical SCI, highest within the 3-to 5-day period following a cervical SCI, and declines rapidly 2 weeks after injury.…”

Section: Introductionmentioning

confidence: 99%

Cardiac pacing in patients with a cervical spinal cord injury

et al. 2010

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Study design: Retrospective medical record review. Objectives: To compare patients, admitted to an intensive care unit (ICU) with an acute cervical spinal cord injury (SCI) and documented motor deficit, who did, with those who did not, require a cardiac pacemaker. Setting: South Australian Tertiary Referral Intensive Care and Spinal Injury Unit. Methods: Retrospective medical record review and data set linkage. Results: From 1995 to 2007, 465 patients sustained a cervical SCI. Of these, 30 (6.5%) were admitted to ICU with a clinically assessable motor deficit and 3 (0.6% of all patients, or 10% of those admitted to ICU) required a cardiac pacemaker. All three patients had a cervical SCI, C5 (American Spinal Injury Association A) tetraplegia, and required invasive mechanical respiratory and inotropic support and a tracheostomy for weaning. Two patients (66%) were discharged alive to rehabilitation. Patients requiring a pacemaker had bradycardic episodes over a longer period (11 vs 4 days, P ¼ 0.01), a trend towards a later onset of bradycardia (8 vs 1.5 days, P ¼ 0.05) and a longer ICU length of stay (37 vs 10 days, P ¼ 0.02). Conclusion: Patients with a cervical SCI requiring a cardiac pacemaker are characterized by a higher level of SCI injury and motor loss, require mechanical respiratory and inotropic support, a tracheostomy to wean, and bradycardic episodes of a later onset and over a longer period of time. These findings suggest that such patients should be managed at hospitals with specialized acute spinal injury, intensive care and cardiac pacemaker services.

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“…In patients with cervical cord injury, bradycardia and hypotension may occur due to suppression of the sympathetic tone following predominance of the vagus. 10,11 The autonomic nervous system regulates many different target tissues in the somatic and visceral domains of the body in a differentiated manner, indicating that there apparently exist separate sympathetic pathways that are functionally defined by their target cells. 12 Most of the actions of the autonomic nervous system are involuntary, whereas some activities, such as breathing, can also be controlled by conscious patients.…”

Section: Discussionmentioning

confidence: 99%

Importance of checking prehospital neurological findings to reveal incidence of spinal cord concussion

Yanagawa

Miyawaki

2012

Spinal Cord

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Objective: To clarify the incidence and characteristics of spinal cord concussion in an urban city in Japan. Methods: The current retrospective study was conducted by reviewing the medical records of patients with spinal cord injuries admitted between January 2007 and December 2010. The subjects were divided into two groups: a spinal cord concussion group and a spinal cord injury group. Results: There were 36 patients with spinal cord injuries admitted during this period. Among them, there were 8 patients with spinal cord concussions. No significant differences were apparent between the two groups with regard to sex, mechanism of injury, Glasgow Coma Scale, incidence of shock, inhospital Frankel classification, level of spinal cord injury, frequency of vertebral dislocation/fracture, surgery and the survival rate. However, the mean age in the spinal cord concussion group was lower than that in the spinal cord injury group. The systolic blood pressure, the heart rate and the diameter of minimum spinal canal in the concussion group were all higher than those in the spinal cord injury group. Half of the subjects in the spinal cord concussion group demonstrated immediate neurological improvement between prehospital and inhospital findings, however none of the subjects in the spinal cord injury group demonstrated such improvement. This difference was statistically significant. Conclusion: Spinal cord concussion is not rare in urban Japan. Checking neurological findings at the scene leads to the revelation of the true high incidence of spinal cord concussion among spinal cord injuries.

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Cervical Spinal Cord Injury and the Need for Cardiovascular Intervention

Cited by 105 publications

References 19 publications

Peripheral vascular function in spinal cord injury: a systematic review

Peripheral vascular function in spinal cord injury: a systematic review

Cardiac pacing in patients with a cervical spinal cord injury

Importance of checking prehospital neurological findings to reveal incidence of spinal cord concussion

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