Long-term experience with diaphragm pacing for traumatic spinal cord injury: Early implantation should be considered

Surgery. 2018 Oct;164(4):705-711. doi: 10.1016/j.surg.2018.06.050. Epub 2018 Sep 6.


Background: Cervical spinal cord injury can result in catastrophic respiratory failure requiring mechanical ventilation with high morbidity, mortality, and cost. Diaphragm pacing was developed to replace/decrease mechanical ventilation. We report the largest long-term results in traumatic cervical spinal cord injury.

Methods: In this retrospective review of prospective institutional review board protocols, all patients underwent laparoscopic diaphragm mapping and implantation of electrodes for diaphragm strengthening and ventilator weaning.

Results: From 2000 to 2017, 92 patients out of 486 diaphragm pacing implants met the criteria. The age at time of injury ranged from birth to 74 years (average: 27 years). Time on mechanical ventilation was an average of 47.5 months (range, 6 days to 25 years, median = 1.58 years). Eighty-eight percent of patients achieved the minimum of 4 hours of pacing. Fifty-six patients (60.8%) used diaphragm pacing 24 hours a day. Five patients had full recovery of breathing with subsequent diaphragm pacing removal. Median survival was 22.2 years (95% confidence interval: 14.0-not reached) with only 31 deaths. Subgroup analysis revealed that earlier diaphragm pacing implantation leads to greater 24-hour use of diaphragm pacing and no need for any mechanical ventilation.

Conclusion: Diaphragm pacing can successfully decrease the need for mechanical ventilation in traumatic cervical spinal cord injury. Earlier implantation should be considered.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cervical Vertebrae
  • Child
  • Child, Preschool
  • Diaphragm*
  • Electric Stimulation Therapy*
  • Electrodes, Implanted*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Laparoscopy*
  • Male
  • Middle Aged
  • Respiration, Artificial
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / mortality
  • Respiratory Insufficiency / therapy*
  • Retrospective Studies
  • Spinal Cord Injuries / complications*
  • Spinal Cord Injuries / mortality
  • Treatment Outcome
  • Young Adult