title: Functional restoration of the paralyzed diaphragm in high cervical quadriplegia via phrenic nerve neurotization utilizing the functional spinal accessory nerve.
abstract: The authors report a case of functional improvement of the paralyzed diaphragm in high cervical quadriplegia via phrenic nerve neurotization using a functional spinal accessory nerve. Complete spinal cord injury at the C-2 level was diagnosed in a 44-year-old man. Left diaphragm activity was decreased, and the right diaphragm was completely paralyzed. When the level of metabolism or activity (for example, fever, sitting, or speech) slightly increased, dyspnea occurred. The patient underwent neurotization of the right phrenic nerve with the trapezius branch of the right spinal accessory nerve at 11 months postinjury. Four weeks after surgery, training of the synchronous activities of the trapezius muscle and inspiration was conducted. Six months after surgery, motion was observed in the previously paralyzed right diaphragm. The lung function evaluation indicated improvements in vital capacity and tidal volume. This patient was able to sit in a wheelchair and conduct outdoor activities without assisted ventilation 12 months after surgery.
authors.affiliation: Department of Spinal and Neural Function Reconstruction, China Rehabilitation Research Center, Beijing, China.
authors.forename: Ming-liang
authors.initials: ML
authors.lastname: Yang
authors.forename: Jian-jun
authors.initials: JJ
authors.lastname: Li
authors.forename: Shao-cheng
authors.initials: SC
authors.lastname: Zhang
authors.forename: Liang-jie
authors.initials: LJ
authors.lastname: Du
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.forename: Yu-ming
authors.initials: YM
authors.lastname: Wang
authors.forename: Hui-ming
authors.initials: HM
authors.lastname: Gong
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
mesh_terms: D000055:Accessory Nerve / Q000503:physiopathology / Q000637:transplantation*; D000328:Adult; D003964:Diaphragm / Q000294:innervation* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D016067:Nerve Transfer / Q000379:methods*; D010791:Phrenic Nerve / Q000503:physiopathology / Q000601:surgery; D011782:Quadriplegia / Q000503:physiopathology / Q000601:surgery*; D020127:Recovery of Function / Q000502:physiology*; D012133:Respiratory Paralysis / Q000503:physiopathology / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome