Phrenic Nerve Graft Helps Quadriplegics Breathe

Phrenic Nerve Graft Helps Quadriplegics Breathe

For patients left paralyzed from a spinal cord injury in the cervical or neck area, breathing is a constant challenge that threatens one's independence, emotional well being and health. For the first time, a procedure is available to regenerate the damaged phrenic nerve, which cues the diaphragm to move the lungs.

Abbott J. Krieger, MD, a neurosurgeon in private practice in Livingston, New Jersey, has been working for more than 20 years to repair the phrenic nerve, re-animate the diaphragm muscles and free quadriplegics confined for life to ventilators. Dr. Krieger will be presenting the results of his research to more than 2,500 neurosurgeons and allied health professionals at the Congress of Neurological Surgeons 49th Annual Meeting, October 30 - November 4, 1999 in Boston, Massachusetts.

"This procedure will open up a tremendous opportunity for patients who have lost the ability to move and breathe on their own - without the aid of a respirator - due to spinal cord injury or disease, or damage to the phrenic nerve," said Dr. Krieger. "It marks the first time that nerve restoration surgery has been used to free permanent prisoners of a ventilator from their misery."

The procedure, which has been successfully performed in six patients with dead or damaged phrenic nerves, works by grafting a living, intercostal nerve into the phrenic nerve. After approximately six months, nerve regeneration occurs and takes over the electrical functions of the phrenic nerve. A pacemaker is inserted to help the fused nerve send the correct "breathe" signal to the brain.

The pacemaker, similar to the ones used in cardiac patients, consists of electrodes sutured to the phrenic nerves, radio receivers implanted into subcutaneous pockets, and an external transmitter/antenna that provides power to the system via 9-volt batteries. The external transmitter and antenna send energy and stimulus information to the receiver implant, which are translated into radio waves, or stimulating pulses, and delivered to the phrenic nerve via the electrodes. The repetitive stimulus patterns to the phrenic nerve results in smooth, rhythmic contractions of the diaphragm, which allow the patient to breathe on his or her own.

"Pacing the phrenic nerve is not new, per se; it has been done for more than 20 years on patients with an intact phrenic nerve, but in whom the spinal cord is not sending appropriate signals," said Dr, Krieger. "This trial, however, marks the first time nerve transfers have been used to re-animate the phrenic nerve in patients with damage to the nerve itself or with damage to the nerve cells in the spinal cord."

Approximately 450,000 people in the United States have sustained spinal cord injuries, with more than 10,000 new cases emerging each year. Overall, more than half of all spinal cord injuries result in quadriplegia, leaving victims dependent on ventilators to breathe.

"Breathing through a ventilator wears on the body and makes quadriplegics more susceptible to fever, infections and pneumonia -- the primary case of death in quadriplegics," said Dr. Krieger. "This procedure eliminates the brute force of the ventilator and reproduces the smoothness of the natural breathing process, thereby prolonging the lifespan of many quadriplegics."

Dr. Krieger plans to continue his research in this area and explore how neurotrophic factors can be used to speed the healing process in patients with phrenic nerve grafts. "Given the success of this research, I plan to look at ways to use this technique to make the phrenic nerve procedure a quicker, safer, and more routine operation, so that more patients will be eligible to receive its benefits."

Founded in 1951, the Congress of Neurological Surgeons (CNS) is a scientific and educational association with approximately 4,800 members worldwide. The CNS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. Neurological surgery is the medical specialty concerned with the diagnosis and treatment of patients with injury to, or diseases of, the brain, spine and peripheral nerves.

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Media Representatives: To view the online press room, visit http://www.neurosurgery.org/pubpages/news/cn99mediakit.html. If you would like to cover the meeting or interview a neurosurgeon - either on-site or via telephone - please contact Deia Lofendo at (847) 518-2519 or call the Annual Meeting press room beginning Sunday, October 31, at (617) 954-2595.