J reconstr Microsurg 2015; 31(05): 391-395
DOI: 10.1055/s-0035-1549159
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Diaphragmatic Reinnervation in Ventilator-Dependent Patients with Cervical Spinal Cord Injury and Concomitant Phrenic Nerve Lesions Using Simultaneous Nerve Transfers and Implantable Neurostimulators

Matthew R. Kaufman
1  The Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
2  The Institute for Advanced Reconstruction, Shrewsbury, New Jersey
3  Division of Plastic and Reconstructive Surgery, David Geffen UCLA Medical Center, Los Angeles, California
,
Andrew I. Elkwood
1  The Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
2  The Institute for Advanced Reconstruction, Shrewsbury, New Jersey
,
Farid Aboharb
2  The Institute for Advanced Reconstruction, Shrewsbury, New Jersey
,
John Cece
2  The Institute for Advanced Reconstruction, Shrewsbury, New Jersey
,
David Brown
4  Department of Rehabilitative Medicine, JFK Johnson Rehabilitation Institute, Edison, New Jersey
,
Kameron Rezzadeh
3  Division of Plastic and Reconstructive Surgery, David Geffen UCLA Medical Center, Los Angeles, California
,
Reza Jarrahy
3  Division of Plastic and Reconstructive Surgery, David Geffen UCLA Medical Center, Los Angeles, California
› Author Affiliations
Further Information

Publication History

04 November 2014

01 February 2015

Publication Date:
13 April 2015 (eFirst)

Abstract

Background Patients who are ventilator dependent as a result of combined cervical spinal cord injury and phrenic nerve lesions are generally considered to be unsuitable candidates for diaphragmatic pacing due to loss of phrenic nerve integrity and denervation of the diaphragm. There is limited data regarding efficacy of simultaneous nerve transfers and diaphragmatic pacemakers in the treatment of this patient population.

Methods A retrospective review was conducted of 14 consecutive patients with combined lesions of the cervical spinal cord and phrenic nerves, and with complete ventilator dependence, who were treated with simultaneous microsurgical nerve transfer and implantation of diaphragmatic pacemakers. Parameters of interest included time to recovery of diaphragm electromyographic activity, average time pacing without the ventilator, and percent reduction in ventilator dependence.

Results Recovery of diaphragm electromyographic activity was demonstrated in 13 of 14 (93%) patients. Eight of these 13 (62%) patients achieved sustainable periods (>1 h/d) of ventilator weaning (mean = 10 h/d [n = 8]). Two patients recovered voluntary control of diaphragmatic activity and regained the capacity for spontaneous respiration. The one patient who did not exhibit diaphragmatic reinnervation remains within 12 months of initial treatment. Surgical intervention resulted in a 25% reduction (p < 0.05) in ventilator dependency.

Conclusion We have demonstrated that simultaneous nerve transfers and pacemaker implantation can result in reinnervation of the diaphragm and lead to successful ventilator weaning. Our favorable outcomes support consideration of this surgical method for appropriate patients who would otherwise have no alternative therapy to achieve sustained periods of ventilator independence.