Abstract
Return of diaphragm function in an individual with ventilator-dependent high cervical tetraplegia is presented. The patient was maintained on a ventilator for five years after sustaining a C3-C4 vertebral fracture with a complete high cervical tetraplegia. Diaphragmatic fluoroscopic evaluation at the initial injury time revealed a nonfunctioning diaphragm, and the patient was subsequently discharged home on a portable ventilator. Respiratory evaluation 5 years post injury, including, diaphragmatic fluoroscopy, transcutaneous phrenic nerve conduction studies and pulmonary function tests, revealed intact phrenic nerve function bilaterally with spontaneous diaphragmatic motion. Subsequently, successful ventilatory weaning and diaphragmatic muscle strengthening was achieved. This case report emphasises the importance of serial evaluation of phrenic nerve viability, diaphragmatic function and ventilator dependency in patients with a high cervical tetraplegia in light of potential neurological recovery.
Similar content being viewed by others
Article PDF
References
Dureene J, Maclem P and Roussos C . The respiratory muscles: mechanism, control and pathophysiology. Am Rev Respir Dis 1978; 118: 119–133.
Bergofsky E . Mechanism for respiratory insufficiency after cervical cord injury: a source of alveolar hypoventilation. Ann Intern Med 1964; 61: 435–447.
Carter R . Medical management of pulmonary complications of spinal cord injury. Adv Neurol 1979; 22: 261–269.
Wicks A and Menter R . Long-term outlook in quadriplegic patients with initial ventilator dependency. Chest 1986; 90: 406–410.
Goldberg A . Home care for a better life for ventilator-dependent people. Chest 1983; 84: 365–366.
Donovan W and Taylor N . Ventilatory assistance in quadriplegia. Arch Phys Med Rehab 1973; 54: 485–488.
Ditunno J, Stover S and Freed M . Motor recovery of the upper extremities in traumatic quadriplegia: A multicenter study. Arch Phys Med Rehabil 1992; 73: 431–436.
De Troyer A, Estenne M and Vincken W . Rib cage motion and muscle use in high tetraplegics. Am Rev Respir Dis 1986; 133: 1115–1119.
Bach J and Alba A . Noninvasive options for ventilatory support of the traumatic high level quadriplegia. Chest 1990; 98: 613–619.
Glenn W, Holcomb W and Shaw R . Long-term ventilatory support by diaphragm pacing in quadriplegia. Ann Surg 1976; 183: 566–577.
Montero J, Feldman D and Montero D . Effects of glossopharyngeal breathing on respiratory function after cervical cord transection. Arch Phys Med Rehabil 1967; 48: 650–653.
Stone D and Keltz H . The effect of respiratory muscle dysfunction on pulmonary function: studies in patients with spinal cord injuries. Amer Rev Resp Dis 1963; 88: 621–629.
McMichan J, Michel L and Westbrook P . Pulmonary dysfunction following traumatic quadriplegia. JAMA 1980; 243: 528–531.
Ledsome J and Sharp J . Pulmonary function in acute cervical cord injury. Am Rev Respir Dis 1981; 124: 41–45.
Ditunno J, Sipski M, Posuniak E and Chen Y . Wrist extensor recovery in traumatic quadriplegia. Arch Phys Med Rehab 1987; 68: 287–290.
Lieberman J, et al. Serial phrenic nerve. Nerve conduction studies in candidates for diaphragmatic pacing. Arch Phys Med Rehab 1980; 61: 528–531.
Bellany R, Pitts F and Stauffer E . Respiratory complications in traumatic quadriplegia; analysis of 20 years' experience. J Neurosurg 1973; 39: 596–600.
Whiteneck G, Carter R and Hall K . Collaborative study of high quadriplegia. Arch Phys Med Rehabil 1985: 66: 575.
McKinley A, Auchincloss J and Gilbert R . Pulmonary function, ventilatory control and respiratory complications in quadriplegic subjects. Am Rev Resp Dis 1969; 100: 526–532.
Forner J . Lung volumes and mechanics of breathing in tetraplegics. Paraplegia 1980; 18: 258–266.
Peterson W, Charlifue M and Gerhart R . Two methods of weaning persons with quadriplegia from mechanical ventilators. Paraplegia 1994; 32: 98–103.
Knebel A . Weaning from mechanical ventilation: current controversies. Heart Lung 1991; 20: 321–331.
Gross D, Ladd H and Riley E . The effect of training on strength and endurance of the diaphragm in quadriplegia. Am J Med 1980; 68: 27–35.
Huldtgren A, Fugl-Meyer A and Jonasson E . Ventilatory dysfunction and respiratory rehabilitation in post-traumatic quadriplegia. Eur J Respir Dis 1980; 61: 347–356.
Lerman R and Weiss M . Progressive resistive exercise in weaning high quadriplegics from the ventilator. Paraplegia 1987; 25: 130–135.
Aldrich T, Karpel J and Uhrlass R . Weaning from mechanical ventilation: adjunctive use of inspiratory muscle resistive training. Crit Care Med 1989; 17: 143–147.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
McKinley, W. Late return of diaphragm function in a ventilator-dependent patient with a high cervical tetraplegia: case report, and interactive review. Spinal Cord 34, 626–629 (1996). https://doi.org/10.1038/sc.1996.112
Issue Date:
DOI: https://doi.org/10.1038/sc.1996.112