Quadriplegic Man Breathes Independently After Rare Neuromodulation Surgery

Ruby Hall Clinic in Pune successfully performed Maharashtra’s first Phrenic Nerve Neuromodulation surgery, helping a 58-year-old quadriplegic man regain independent breathing after six months of ventilator dependence due to a severe spinal cord injury.

Sanjay Yashwant Pai had a severe cervical spine fracture (C3-C4) after a fall in the bathroom. Despite performing spinal surgeries, including corpectomy, discectomy, and spinal fusion at another hospital, he remained paralyzed and unable to breathe without mechanical support.

When he was transferred to Ruby Hall Clinic, Mr. Pai had mechanical ventilation, was conscious, had enteral feeding, and medications to prevent infections. Addressing the implications of prolonged ventilation, such as pneumonia, blood clots, and tracheal complications, the multidisciplinary team, led by Dr. Kapil Zirpe, Dr. Manish Baldia, and Dr. Richa Singh, decided to attempt a rarely performed procedure: phrenic nerve stimulation.

The neuromodulation technique is implemented by an implanted device that transmits electrical pulses to the phrenic nerve, causing the diaphragm ⁽¹⁾ to contract and produce a natural breathing rhythm. The external transmitter connects with the implant, providing controlled breathing support tailored to the patient’s physiological needs.

Following the surgery, Mr. Pai had steady respiratory improvement and was gradually weaned off the ventilator. Eventually, he was shifted out of intensive care for continued rehabilitation.

How Phrenic Nerve Stimulation Helps

The phrenic nerve runs from the neck to the diaphragm and controls its movement, which is essential for breathing. For those patients with spinal cord injuries with no phrenic nerves ⁽²⁾ and diaphragm involvement, this stimulation can restore breathing function without ventilator support.

Key benefits include:

• More autonomy and ability to participate in daily life.

• Lowered risks of lung infections, blood clots, and tracheal injuries.

• Preservation of the sense of smell and phonation

• Increase in oxygenation and secretion clearance, leading to fewer respiratory problems.

Looking Ahead: Broader Applications

Though suitable for only selected patients, phrenic nerve stimulation offers medical and quality-of-life benefits. Researchers now focus on its use in conditions like central sleep apnoea and amyotrophic lateral sclerosis (ALS). Newer Strategies, such as transvenous (endovascular) stimulation, may allow for non-surgical approaches, further expanding their reach in critical care and rehabilitation.

References:

1. Avery Biomedical Devices. “How Phrenic Nerve Stimulation Works.” Accessed May 1, 2025. https://www.averybiomedical.com/phrenic-nerve-stimulation-works/#:~:text=Common%20diagnoses%20include%20patients%20with,more%20about%20the%20surgical%20details.

2. Onders, Raymond P., Joseph C. Elmo, Ajay Khansarinia, Robert J. Bowman, Anthony M. Yee, and Andres I. Ochoa. “Complete Worldwide Operative Experience in Thoracic Epidural Stimulation: Results and Lessons Learned.” Journal of Clinical Neuroscience 22, no. 10 (2015): 1536–42. https://www.sciencedirect.com/science/article/pii/S1877065715000822.

(Input from various sources)

(Rehash/Dr. Anjaly KTK/MSM)