Mapping the phrenic nerve motor point: The key to a successful laparoscopic diaphragm pacing system in the first human series

Onders, Raymond P.; DiMarco, Anthony F.; Ignagni, Anthony; Aiyar, Harish; Mortimer, J.T.

doi:10.1016/j.surg.2004.06.030

Cited by 79 publications

(55 citation statements)

References 10 publications

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“…The receiver/stimulator is implanted subcutaneously through a second incision, which is usually made in the lower anterolateral chest wall and connected to the electrodes by wires placed subcutaneously. In recent years, minimally invasive laparoscopic techniques have permitted implantation of intramuscular diaphragm electrodes near the diaphragm's motor points [70][71][72] (Figure 8), a technique which reduces the length of surgery time and minimizes the trauma to the person. Postoperatively, the diaphragm is gradually reconditioned to reverse disuse atrophy and to regain strength and endurance.…”

Section: 68mentioning

confidence: 99%

“…In recent years, it has been shown that accurate mapping of the phrenic nerve motor points permits successful laparoscopic implantation of intramuscular electrodes within the costal portion of each hemi-diaphragm. 51,73,71,72 Such procedure involves placement of four laparoscopic ports to the abdominal cavity for creation of a pneumoperitoeum, visualization of the diaphragm, diaphragmatic mapping by electrical stimulation and implantation of two electrodes at the motor points in each hemi-diaphragm. 73 The electrode wires are tunneled subcutaneously to the chest wall where they exit and connect to an external stimulator.…”

Section: 68mentioning

confidence: 99%

“…Such system is felt to be low risk, cost-effective and implantable during and outpatient visit. 71 Early implantation, even within weeks of acute SCI, of all system components is ultimately envisioned. 71 DiMarco et al 73 have recently described in detail shortcomings of currently used EPR systems and outlined needs for their further development.…”

Section: 68mentioning

confidence: 99%

“…71 Early implantation, even within weeks of acute SCI, of all system components is ultimately envisioned. 71 DiMarco et al 73 have recently described in detail shortcomings of currently used EPR systems and outlined needs for their further development. In most cases, viability of only one phrenic nerve is not sufficient to allow breathing exclusively by EPR only.…”

Section: 68mentioning

confidence: 99%

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Functional electrical stimulation after spinal cord injury: current use, therapeutic effects and future directions

2007

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Repair of the injured spinal cord by regeneration therapy remains an elusive goal. In contrast, progress in medical care and rehabilitation has resulted in improved health and function of persons with spinal cord injury (SCI). In the absence of a cure, raising the level of achievable function in mobility and selfcare will first and foremost depend on creative use of the rapidly advancing technology that has been so widely applied in our society. Building on achievements in microelectronics, microprocessing and neuroscience, rehabilitation medicine scientists have succeeded in developing functional electrical stimulation (FES) systems that enable certain individuals with SCI to use their paralyzed hands, arms, trunk, legs and diaphragm for functional purposes and gain a degree of control over bladder and bowel evacuation. This review presents an overview of the progress made, describes the current challenges and suggests ways to improve further FES systems and make these more widely available.

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Section: 68mentioning

confidence: 99%

Section: 68mentioning

confidence: 99%

Section: 68mentioning

confidence: 99%

Section: 68mentioning

confidence: 99%

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Functional electrical stimulation after spinal cord injury: current use, therapeutic effects and future directions

2007

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“…Diaphragm pacing stimulation (DPS) utilizes electrical stimulation to liberate an individual with chronic respiratory insufficiency or failure due to high cervical SCI from dependence on mechanical positive pressure ventilation (PPV) via a tracheostomy [44,45]. Diaphragm pacing includes options of phrenic nerve pacing and laparoscopic diaphragm pacing.…”

Section: Respiratory Insufficiencymentioning

confidence: 99%

Pediatric Spinal Cord Injury

Osorio¹,

Reyes²,

Massagli³

2014

Curr Phys Med Rehabil Rep

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Traumatic spinal cord injury (SCI) occurs much less commonly in children than adults. Children can also experience spinal cord dysfunction from birth injuries, skeletal dysplasias, neoplasms, infections, and autoimmune causes. There are special considerations for determining the level and completeness of injury in children under 6 years of age. Children with SCI experience some unique secondary complications such as scoliosis, and other complications such as autonomic dysreflexia require modifications in management due to pediatric physiology. The rehabilitation of children with SCI typically includes compensatory strategies and exercise, and new methods of exercise including functional electrical stimulation and activity-based locomotor training are being researched for efficacy in restoration of function. Studies of psychosocial health of children with SCI highlight the importance of peer interactions and participation in activities outside the home. Practitioners also need to be mindful of the stress an injury places on siblings, parents, and other caregivers.

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Phrenic nerve conduction studies in spinal cord injury: Applications for diaphragmatic pacing

et al. 2008

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The diaphragm pacing system (DPS) is a minimally invasive alternative to mechanical ventilation in patients with quadriplegia due to cervical myelopathy primarily caused by high cervical spinal cord injury. We evaluated 36 patients, 29 of whom had traumatic spinal cord injury, two who had a history of remote meningitis and demyelinating disease, and five who had cervical myelopathies of unknown etiology. Phrenic nerve conduction studies were performed with simultaneous fluoroscopic observation of diaphragm excursion to assess diaphragm viability. In the preoperative evaluation, diaphragm compound muscle action potentials (CMAPs) were recorded only when the diaphragm moved on fluoroscopy with ipsilateral stimulation. Twenty-six patients who were determined to have a viable diaphragm underwent DPS. Following DPS the primary outcome was the time (hours per day) that patients were able to pace and stay off the ventilator. Of 26 implanted patients, 96% (25 patients) were able to pace and tolerate being off the ventilator for more than 4 h per day. This study demonstrates that the presence of a diaphragm CMAP is associated with diaphragm movement observed by fluoroscopy in cervical myelopathy. In addition, DPS can help patients with cervical spinal cord injury to breathe unassisted by a ventilator.

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Mapping the phrenic nerve motor point: The key to a successful laparoscopic diaphragm pacing system in the first human series

Cited by 79 publications

References 10 publications

Functional electrical stimulation after spinal cord injury: current use, therapeutic effects and future directions

Functional electrical stimulation after spinal cord injury: current use, therapeutic effects and future directions

Pediatric Spinal Cord Injury

Phrenic nerve conduction studies in spinal cord injury: Applications for diaphragmatic pacing

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