Successful management of respiratory paralysis by phrenic nerve pacing in upper cervical cord injury: A case report.

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A 32-year-old man sustained a fracture-dislocation of the atlantoaxial junction in a motorcycle accident, causing quadriplegia and apnoea in June, 1987. After twenty days, Brooks fusion of Cl-2 was performed. After five and six months, the bilateral implantations of radiofrequency-induced phrenic nerve pacemakers were performed.After periods of conditioning, he was able to adapt to continuous and alternating full-time ventilatory support of both diaphragms for more than 3 months. Ventilation was adequate to prevent clinical and radiological evidence of atelectasis. The arterial oxygen pressures were repeatedly within normal limits, indicating adequate ventilation to perfusion ratios in both lungs. Tidal volumes in the 400-700ml range were achieved in supine position. The compliance of the lungs and thorax combined was 0.05L/cmH2O in supine position. They were decreasing in sitting position. When compressing the abdominal contents upward agaist the diaphragm with abdominal bandage, they were improved. Phrenic nerve pacemakers have facilitated discharge from the hospital to a home-based ventilation program.
西日本整形・災害外科学会の論文