Bradycardia Secondary to Cervical Spinal Cord Injury

Abstract

Acute spinal cord injury (SCI) is most commonly traumatic in origin but may also result from degenerative spine disease, ischemia, demyelination, inflammation, or rapidly expanding neoplastic, hemorrhagic, or pyogenic masses (Ghezzi et al, 2001). In the United States, traumatic SCI with or without bony injury has an annual incidence of 28 to 55 per million, with an average of 10,000 new cases a year and a prevalence of 200,000 (Sekhon & Fehlings, 2001). The average age at the time of injury is 32 years and the male/female ratio is 4:1. More than half (55%) of traumatic SCI involves the cervical cord. The most common causes of SCI are traffic accidents (motor vehicle, bicycle, pedestrian) (40%– 50%), assault (10%–25%), falls (20%), work-related injuries (10%–25%), and sports/recreation-related injuries (10%–25%) (Cheung et al, 2002; Surkhin et al, 2000). In traumatic cervical SCI, 3month mortality is 20% to 21%. The independent predictors of mortality are level of cord injury, Glasgow Coma Scale, respiratory failure, and age. Principal causes of death are respiratory disorders, cardiovascular disorders, pulmonary embolism, infections, and suicide (Claxton et al, 1998; DeVivo et al, 1999, Yeo et al, 1998). Cardiovascular disorders are responsible for 40.5% of deaths, being the most common cause of mortality in patients with SCI (Garshick et al, 2005).