J Korean Neurosurg Soc.  2013 Oct;54(4):359-362. 10.3340/jkns.2013.54.4.359.

Phrenic Nerve Stimulation for Diaphragm Pacing in a Quadriplegic Patient

• Son BC
• Kim DR
• Kim IS
• Hong JT

• KMID: 1499346
• DOI: http://doi.org/10.3340/jkns.2013.54.4.359

Abstract

Chronic hypoventilation due to injury to the brain stem respiratory center or high cervical cord (above the C3 level) can result in dependence to prolonged mechanical ventilation with tracheostomy, frequent nosocomial pneumonia, and prolonged hospitalization. Diaphragm pacing through electrical stimulation of the phrenic nerve is an established treatment for central hypoventilation syndrome. We performed chronic phrenic nerve stimulation for diaphragm pacing with the spinal cord stimulator for pain control in a quadriplegic patient with central apnea due to complete spinal cord injury at the level of C2 from cervical epidural hematoma. After diaphragmatic pacing, the patient who was completely dependent on the mechanical ventilator could ambulate up to three hours every day without aid of mechanical ventilation during the 12 months of follow-up. Diaphragm pacing through unilateral phrenic nerve stimulation with spinal cord stimulator was feasible in an apneic patient with complete quadriplegia who was completely dependent on mechanical ventilation. Diaphragm pacing with the spinal cord stimulator is feasible and effective for the treatment of the central hypoventilation syndrome.

Keyword

Apnea; Central hypoventilation; Diaphragm pacing; Spinal cord stimulator; Spinal cord injury

MeSH Terms

Apnea
Brain Stem
Diaphragm*
Electric Stimulation
Follow-Up Studies
Hematoma
Hospitalization
Humans
Hypoventilation
Phrenic Nerve*
Pneumonia
Quadriplegia
Respiration, Artificial
Respiratory Center
Sleep Apnea, Central
Spinal Cord
Spinal Cord Injuries
Tracheostomy
Ventilators, Mechanical
Wounds and Injuries

Figure

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  Fig. 1 A : A T2-weighted magnetic resonance imaging (MRI) shows an acute epidural hematoma compressing the cervical spinal cord and causing central apnea and quadriplegia and subsequent development of myelomalacia. B : An MRI taken at postoperative 3 months showing the focal high signal intensity at the C2 level, suggesting focal myelomalacia.

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  Fig. 2 Intraoperative photographs showing the procedure of phrenic nerve stimulation. A : An intraoperative photograph showing the exposure of the right phrenic nerve and location of the electrode along the course of the phrenic nerve. Note the location of the phrenic nerve over the anterior scalene muscle. The sternocleidomastoideus muscle is retracted medially (white arrow : right phrenic nerve, white arrowhead : the omohyoid muscle, black arrow : the scalenus anterior muscle, black arrowhead : an electrode). B : A drawing of an intraoperative photograph showing the anatomical structures.

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