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

Asian Spine J, 2021 · DOI: 10.31616/asj.2020.0227 · Published: December 1, 2021

Spinal Cord Injury Pulmonology Rehabilitation

Simple Explanation

This study discusses using diaphragm pacing with phrenic nerve stimulation (PNS) to help a tetraplegic patient, who was dependent on a ventilator, to breathe on their own. The patient had a spinal cord injury in the neck area. Electrodes were implanted to stimulate the phrenic nerve, which controls the diaphragm. This stimulation helped the patient to wean off the ventilator and breathe independently. After 36 months, the patient remained ventilator-free and experienced an improved quality of life, suggesting that this method could be beneficial for similar patients in developing countries.

Study Duration

36 Months

Participants

One 30-year-old male with posttraumatic tetraplegia

Evidence Level

Technical Note

Key Findings

1
Diaphragm pacing with phrenic nerve stimulation facilitated weaning from mechanical ventilation and spontaneous ventilator-free breathing at 20 weeks post-implantation.
2
At 36 months after implantation, the patient remained ventilator-free without any procedure-related complications or respiratory infections.
3
The patient's pulmonary function improved, with a change in the SCIM III respiration score from 0 to 4 points, and showed improvement in quality of life based on WHOQOL-BREF questionnaire.

Research Summary

The technical note presents a case of a 30-year-old male with posttraumatic tetraplegia and ventilator dependence following a C1–C2 spinal cord injury. Bilateral phrenic nerve stimulator electrodes were implanted to facilitate diaphragm pacing, leading to successful weaning from mechanical ventilation and sustained ventilator-free breathing at 36-month follow-up. The patient experienced improved pulmonary function, enhanced quality of life, and avoided respiratory complications, suggesting the potential of this technique for ventilator-dependent tetraplegics in developing countries.

Practical Implications

Improved Rehabilitation

Diaphragm pacing can enable tetraplegic patients to undergo more effective rehabilitation by freeing them from ventilator dependence.

Cost-Effective Solution

Despite the initial cost, diaphragm pacing can potentially reduce the long-term financial burden associated with managing ventilator-dependent SCI patients.

Enhanced Quality of Life

Successful diaphragm pacing can lead to significant improvements in the patient's quality of life, as demonstrated by improved scores in physical health, psychological well-being, social relationships, and environmental satisfaction.

Study Limitations

1
Single case study limits generalizability.
2
Lack of systematic analysis from developing Asian nations on mortality, morbidity, and cost burden of ventilator-dependent SCI patients.
3
Availability of technical expertise and resources for direct diaphragm electrode pacing in developing countries.

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