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Pulmonary rehabilitation in high cervical spinal cord injury: a series of 133 consecutive cases


Study design

This is a retrospective study.


To detail respiratory management after a high cervical spinal cord injury (HCSCI).


A tertiary university hospital’s pulmonary rehabilitation center to which most individuals with HCSCI and ventilatory insufficiency throughout Korea are referred.


The medical records of individuals with complete or sensory incomplete HCSCI admitted to the pulmonary rehabilitation center and receiving the center’s standard treatment were retrospectively reviewed, focusing on respiratory state transitions.


In total, 133 individuals with a C1–4 neurological level of injury (A: 101 or B: 32 on the American Spinal Injury Association Impairment Scale) were identified; 110 (82.7%) had indwelling tracheostomy tubes at admission and 75 underwent successful decannulation during admission. At the final follow-up, 76 individuals (57.1%) still required mechanical ventilation (MV) and 37 (27.8%) still required indwelling tracheostomy tubes. Of the individuals who had tracheostomy tubes without ventilatory support, 30 underwent decannulation and were discharged without non-invasive MV support. Of those with MV via tracheostomy on admission, 25 were switched to non-invasive MV after decannulation.


Respiratory management in complete or sensory incomplete HCSCI needs to be determined by reflecting the current ventilatory state with a comprehensive evaluation of pulmonary function and ventilatory state monitoring. Pulmonary rehabilitation in individuals with HCSCI should be emphasized in the aspect of improving quality of life by avoiding unwanted tracheostomy and changing management methods depending on their recovery.

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Fig. 1: Flowchart outlining the ventilation support and decannulation process via non-invasive monitoring.
Fig. 2: Initial to final respiratory state transitions.

Data availability

The datasets generated and analyzed in this study are available from the corresponding author on reasonable request.


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We wish to thank the participants and staff at the Pulmonary Rehabilitation Center, Gangnam Severance Hospital, for contributing to this study.

Author information

Authors and Affiliations



JP and S-WK designed and wrote the study protocol and submitted the study to the ethical committee. JP also wrote the report, collected and analyzed data, and interpreted the results. WAC assisted with the protocol design and recruited and managed participants. S-WK contributed insights regarding the results and provided feedback on the manuscript. S-WK confirms the full access to the study data and has final responsibility for the decision to submit for publication.

Corresponding author

Correspondence to Seong-Woong Kang.

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Competing interests

The authors declare no competing interests.

Ethical approval

This study was approved by the Institutional Review Board of Gangnam Severance Hospital (No. 3-2020-0229).

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Park, J., Choi, W.A. & Kang, SW. Pulmonary rehabilitation in high cervical spinal cord injury: a series of 133 consecutive cases. Spinal Cord (2022).

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