Thirty-Six-Month Follow-up of Diaphragm Pacing with Phrenic Nerve Stimulation for Ventilator Dependence in Traumatic Tetraplegia: The Way Forward for Spinal Cord Injury Rehabilitation in a Developing Country

Abstract

Respiratory failure and chronic ventilator dependence in tetraplegics following cervical injuries located high on the spine (C1-C3) constitute significant challenges in the rehabilitation of patients given the occurrence of repeated hospitalizations and an ever-increasing financial burden. A 30-year-old man presented with posttraumatic tetraplegia following an unstable injury at the C1-C2 level with cord compression; he was managed by posterior stabilization and decompression followed by ventilator dependence and no rehabilitation until 6 months postinjury. We implanted phrenic nerve stimulator electrodes bilaterally for indirect diaphragm pacing by an implantable pulse generator that allowed for weaning from mechanical ventilation and spontaneous ventilator-free breathing at 20 weeks post-implantation and which facilitated post-tetraplegia rehabilitation. At 36 months after implantation, the patient is ventilator-free without any procedure-related complications or respiratory infections. Diaphragm pacing with phrenic nerve stimulation may be a way forward for ventilator-dependent tetraplegics in developing countries to pursue effective rehabilitation and improved quality of life.

Epidural electrical stimulation of the cervical spinal cord opposes opioid‐induced respiratory depression

“…Numerous previous investigations have demonstrated the capacity of electrical neuromodulation to enhance or restore respiratory function (DiMarco et al., 2019; Hormigo et al., 2017; Meza et al., 2019; Sunshine et al., 2021). Electrical stimulation of the phrenic nerve has been used to pace the diaphragm to improve respiratory deficits under many pathological conditions, including chronic pulmonary disease (Holmes et al., 1958), SCI (Bezdudnaya et al., 2018; Jarosz et al., 2012; Kandare et al., 2002; Sharma et al., 2021) and amyotrophic lateral sclerosis (De Carvalho et al., 2019). Chronic, intermittent stimulation of the spinal cord may restore the ability to cough in subjects with SCI (DiMarco et al., 2020; Hachmann, Calvert et al., 2017; Hachmann, Grahn et al., 2017; Jarosz et al., 2012; Kandare et al., 2002; Kowalski et al., 2014, 2016).…”

Spinal cord bioelectronic interfaces: opportunities in neural recording and clinical challenges

“…More importantly, individuals with upper cervical injuries lose the function of respiratory muscles and depend on long-term ventilators [204]. This presents issues with motor rehabilitation capacity and the priority for these individuals may instead be neuroprosthetics that can electronically pace the diaphragm, weaning them off ventilators [205]. Additionally, SCR may not have a viable surgical target in high cervical injury and motor volition may need to be extracted from the cortex.…”