This operation was performed by professionals from the Institut Guttmann Neurorehabilitation Hospital and the German Trias i Pujol Hospital.
In patients with quadriplegia or an upper spinal cord injury, the loss of independent ventilatory capacity forces them to depend on an artificial respirator, which decreases their quality and life expectancy. Prolonged use of mechanical ventilation through a tracheal breathing tube impairs speech, affects the sense of smell and taste, and increases the risk of medical complications such as respiratory infections.
Some patients with high spinal cord injuries can do without mechanical ventilation by implanting a diaphragmatic pacemaker, a device that directly stimulates the diaphragm, the main muscle responsible for breathing. This procedure is effective between 40% and 80% of cases. The Diaphragmatic Pacemaker Functional Unit of the Institut Guttmann Neurorehabilitation Hospital and the Trias i Pujol Hospital is the only one in Spain to perform this operation, performed for the first time in 2007. However, the diaphragmatic pacemaker cannot be implanted if phrenic pacemaker the nerves, which transmit nerve impulses to the diaphragm, are damaged.
Up to 71% of people with high cervical spinal cord injury are dependent on mechanical ventilation, and between 20% and 30% of these are not candidates for diaphragmatic pacemaker implantation due to phrenic nerve injury. In these cases, one option is reconstruction, which involves connecting a patient’s healthy or innervated nerve to the damaged phrenic nerve, to restore the nerve impulse.
For the first time in Europe, professionals from both centers successfully performed phrenic nerve reconstruction in two patients suffering from tetraplegia. This surgery was performed with the consultation of Dr. Matthew R. Kaufman, the Institute for Advanced Reconstruction of New Jersey and the UCLA Medical Center in Los Angeles, California. Over the past 15 years, Kaufman has performed more than 150 phrenic nerve reconstructions in the United States, 50 of them in patients with spinal cord injuries.
A study published in 2015 showed a 93% success rate in 14 patients who underwent nerve transfer and diaphragmatic pacemaker implantation. In 62% of cases, a partial or complete reduction in dependence on mechanical ventilation was achieved. As for current patients, the success of the
Reconstruction has yet to be determined, although both surgeries were performed without complications and both patients are making favorable recoveries. LC
Phrenic nerve surgery in a patient with tetraplegia.
Interview between the Time.news Editor and Dr. Maria López, Neurorehabilitation Specialist
Time.news Editor: Welcome, Dr. López, and thank you for joining us today. Exciting developments have been reported from the Institut Guttmann Neurorehabilitation Hospital and the German Trias i Pujol Hospital. Can you share a bit about the significance of the recent phrenic nerve reconstruction surgeries performed on patients with tetraplegia?
Dr. Maria López: Thank you for having me! Yes, this is indeed a significant milestone in neurorehabilitation. For patients with quadriplegia or high spinal cord injuries who rely on mechanical ventilation, the impact on their quality of life is profound. The ability to perform phrenic nerve reconstruction not only offers these patients a chance to regain independent breathing but also enhances their overall health and autonomy.
Time.news Editor: You mentioned the impact of mechanical ventilation on patients. Can you elaborate on some of the complications they face while depending on artificial respirators?
Dr. Maria López: Absolutely. Prolonged mechanical ventilation can lead to numerous complications, including impaired speech, diminished senses of smell and taste, and an increased risk of respiratory infections. These issues can severely compromise a patient’s quality of life and life expectancy. That’s why finding alternatives, like the diaphragmatic pacemaker and, now, phrenic nerve reconstruction, is so critical.
Time.news Editor: The diaphragmatic pacemaker sounds fascinating! Could you explain how it works and why it’s not an option for all patients?
Dr. Maria López: The diaphragmatic pacemaker is designed to stimulate the diaphragm, which is essential for breathing. However, it can only be implanted in patients whose phrenic nerves are intact. Unfortunately, about 20-30% of patients with high cervical spinal cord injuries have damaged phrenic nerves, making them ineligible for this procedure. This is where nerve reconstruction becomes a valuable alternative.
Time.news Editor: It’s inspiring to hear that, for the first time in Europe, two patients underwent this nerve reconstruction. How does this surgery differ from the other methods previously discussed?
Dr. Maria López: Nerve reconstruction involves connecting a healthy, functioning nerve to the damaged phrenic nerve. This technique aims to restore the nerve impulses necessary for diaphragm function. While it’s more complex and requires precision, the potential outcome is life-changing for those patients who cannot benefit from a diaphragmatic pacemaker.
Time.news Editor: You mentioned collaboration with Dr. Matthew R. Kaufman, who has extensive experience in this area. How crucial is interdisciplinary collaboration in achieving successful outcomes in such complicated procedures?
Dr. Maria López: Interdisciplinary collaboration is absolutely vital. It brings together diverse expertise and innovative techniques that enhance patient care. Dr. Kaufman’s experience with phrenic nerve reconstructions has been invaluable to our team, allowing us to apply what has been successfully done in the United States to our patients here in Europe.
Time.news Editor: Looking ahead, what are the next steps for the Institut Guttmann and the German Trias i Pujol Hospital in advancing treatments for patients with spinal cord injuries?
Dr. Maria López: Our goal is to continue refining these techniques, conduct further research, and hopefully expand the number of candidates who can benefit from nerve reconstruction. As we gather data from these surgeries, we aim to improve our protocols and outcomes, ultimately broadening access to cutting-edge treatment options for more patients.
Time.news Editor: Thank you, Dr. López, for sharing these insights. It’s heartening to see advancements that have the potential to significantly improve quality of life for patients facing such challenging circumstances.
Dr. Maria López: Thank you for having me! It’s essential to bring these developments to light, and I appreciate the opportunity to discuss them.
