Long-Term Follow-Up after Phrenic Nerve Reconstruction for Diaphragmatic Paralysis: A Review of 180 Patients.
BackgroundPhrenic nerve reconstruction has been evaluated as a method of restoring functional activity and may be an effective alternative to diaphragm plication. Longer follow-up and a larger cohort for analysis are necessary to confirm the efficacy of this procedure for diaphragmatic paralysis.MethodsA total of 180 patients treated with phrenic nerve reconstruction for chronic diaphragmatic paralysis were followed for a median 2.7 years. Assessment parameters included: 36-Item Short Form Health Survey (SF-36) physical functioning survey, spirometry, chest fluoroscopy, electrodiagnostic evaluation, a five-item questionnaire to assess specific functional issues, and overall patient-reported outcome.ResultsOverall, 134 males and 46 females with an average age of 56 years (range: 10-79 years) were treated. Mean baseline percent predicted values for forced expiratory volume in 1 second, forced vital capacity, vital capacity, and total lung capacity, were 61, 63, 67, and 75%, respectively. The corresponding percent improvements in percent predicted values were: 11, 6, 9, and 13% (p≤ 0.01; ≤ 0.01; ≤ 0.05; ≤ 0.01). Mean preoperative SF-36 physical functioning survey scores were 39%, and an improvement to 65% was demonstrated following surgery (p≤ 0.0001). Nerve conduction latency, improved by an average 23% (p≤ 0.005), and there was a corresponding 125% increase in diaphragm motor amplitude (p≤ 0.0001). A total of 89% of patients reported an overall improvement in breathing function.ConclusionLong-term assessment of phrenic nerve reconstruction for diaphragmatic paralysis indicates functional correction and symptomatic relief.
Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey.
Matthew R
MR
Kaufman
Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey.
Andrew I
AI
Elkwood
Department of Physical Medicine and Rehabilitation, JFK Medical Center, Edison, New Jersey.
David
D
Brown
Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey.
John
J
Cece
Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey.
Catarina
C
Martins
Division of Thoracic Surgery, Jersey Shore University Medical Center, Neptune, New Jersey.
Thomas
T
Bauer
Department of Surgery, Robert Wood Johnson University Medical Center, New Brunswick, New Jersey.
Jason
J
Weissler
Division of Plastic and Reconstructive Surgery, David Geffen UCLA Medical Center, Los Angeles, California.
Kameron
K
Rezzadeh
Division of Plastic and Reconstructive Surgery, David Geffen UCLA Medical Center, Los Angeles, California.
Reza
R
Jarrahy
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003964:Diaphragm / Q000294:innervation* / Q000503:physiopathology / Q000601:surgery; D004576:Electromyography; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010791:Phrenic Nerve / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012133:Respiratory Paralysis / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013147:Spirometry; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult