Diaphragm pacing in a high cervical spinal cord injury patient:A case report

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  • ASAHI Takashi
    Department of Health Crisis Management Medicine, Graduate School of Medicine, University of Toyama Department of Neurosurgery Faculty of Medicine, University of Toyama
  • HAMADA Hideo
    Department of Neurosurgery Faculty of Medicine, University of Toyama
  • TAIRA Takaomi
    Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University
  • WAKASUGI Masahiro
    Department of Health Crisis Management Medicine, Graduate School of Medicine, University of Toyama
  • TANGE Daisuke
    Department of Emergency and Disaster Medicine, Faculty of Medicine, University of Toyama
  • OKAZAWA Seisuke
    Department of Emergency and Disaster Medicine, Faculty of Medicine, University of Toyama
  • TOKUI Koutaro
    Department of Emergency and Disaster Medicine, Faculty of Medicine, University of Toyama
  • TSUTSUI Mio
    Department of Emergency and Disaster Medicine, Faculty of Medicine, University of Toyama
  • HAYASHI Nakamasa
    Department of Neurosurgery Faculty of Medicine, University of Toyama
  • ENDO Shunro
    Department of Neurosurgery Faculty of Medicine, University of Toyama
  • OKUDERA Hiroshi
    Department of Health Crisis Management Medicine, Graduate School of Medicine, University of Toyama

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Other Title
  • 高位頚髄損傷による呼吸筋麻痺に対し横隔膜神経刺激療法を行った１例
  • 症例報告 高位頚髄損傷による呼吸筋麻痺に対し横隔膜神経刺激療法を行った1例
  • ショウレイ ホウコク コウイ ケイズイ ソンショウ ニ ヨル コキュウキン マヒ ニ タイシ オウカクマク シンケイ シゲキ リョウホウ オ オコナッタ 1レイ

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We report a case of phrenic nerve pacing with electrical stimulation for the treatment of high cervical spinal cord injury. A sixty-two year-old female patient suffered an atlanto-axial dislocation, high cervical spinal cord injury, lower brain stem injury brain contusion, bilateral lower limb fractures and a mandible fracture as a result of a motor vehicle accident. Consciousness disturbance, respiratory insufficiency and complete tetraplegia resulted. Tracheotomy and artificial ventilation were subsequently performed. Respiratory insufficiency and complete tetraplegia remained unaltered, although consciousness gradually improved to near alertness. In order to allow cessation of daytime use of the respirator, diaphragm pacing was performed 86 days after injury. One month later, the patient was independent of the respirator for up to 11 hours a day. This enabled her to go to the X-ray room, bathe and go outside in a wheelchair without the respirator. Permanent use of a ventilator in patients with respiratory insufficiency secondary to high cervical spinal cord injury results in a great burden of care to family and nursing staff. In the case, diaphragm pacing was effective in reducing nursing and medical effort and improving the patient’s activity field and quality of life.

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