Phrenic nerve neurotization utilizing the spinal accessory nerve: Technical note with potential application in patients with high cervical quadriplegia

R. Shane Tubbs, Blake Pearson, Marios Loukas, Ghaffar Shokouhi, Mohammadali Mohajel Shoja, W. Jerry Oakes

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Introduction: High cervical quadriplegia is associated with high morbidity and mortality. Artificial respiration in these patients carries significant long-term risks such as infection, atelectasis, and respiratory failure. As phrenic nerve pacing has been proven to free many of these patients from ventilatory dependency, we hypothesized that neurotization of the phrenic nerve with the spinal accessory nerve (SAN) may offer one potential alternative to phrenic nerve stimulation via pacing and may be more efficacious and longer lasting without the complications of an implantable device. Materials and methods: Ten cadavers (20 sides) underwent exposure of the cervical phrenic nerve and the SAN in the posterior cervical triangle. The SAN was split into anterior and posterior halves and the anterior half transposed to the ipsilateral phrenic nerve as it crossed the anterior scalene muscle. Results: The mean distance between the cervical phrenic nerve and the SAN in the posterior cervical triangle was 2.5 cm proximally, 4 cm at a midpoint, and 6 cm distally. The range for these measurements was 2 to 4 cm, 3.5 to 5 cm, and 4 to 8.5 cm, respectively. The mean excess length of SAN available after transposition to the more anteromedially placed phrenic nerve was 5 cm (range 4 to 6.5 cm). The mean diameter of these regional parts of the spinal accessory and phrenic nerves was 2 and 2.5 mm, respectively. No statistically significant difference was found for measurements between sides. Conclusions: To our knowledge, using the SAN for neurotization to the phrenic nerve for potential use in patients with spinal cord injury has not been previously explored. Following clinical trials, these data may provide a mechanism for self stimulation of the diaphragm and obviate phrenic nerve pacing in patients with high cervical quadriplegia. Our study found that such a maneuver is technically feasible in the cadaver.

Original languageEnglish (US)
Pages (from-to)1341-1344
Number of pages4
JournalChild's Nervous System
Volume24
Issue number11
DOIs
StatePublished - Jun 9 2008
Externally publishedYes

Fingerprint

Accessory Nerve
Nerve Transfer
Phrenic Nerve
Quadriplegia
Cadaver
Self Stimulation
Pulmonary Atelectasis
Diaphragm
Spinal Cord Injuries
Artificial Respiration
Respiratory Insufficiency
Clinical Trials

Keywords

  • Anatomy
  • Diaphragm
  • Neurotization
  • Spinal cord injury

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Phrenic nerve neurotization utilizing the spinal accessory nerve : Technical note with potential application in patients with high cervical quadriplegia. / Tubbs, R. Shane; Pearson, Blake; Loukas, Marios; Shokouhi, Ghaffar; Mohajel Shoja, Mohammadali; Oakes, W. Jerry.

In: Child's Nervous System, Vol. 24, No. 11, 09.06.2008, p. 1341-1344.

Research output: Contribution to journalArticle

Tubbs, R. Shane ; Pearson, Blake ; Loukas, Marios ; Shokouhi, Ghaffar ; Mohajel Shoja, Mohammadali ; Oakes, W. Jerry. / Phrenic nerve neurotization utilizing the spinal accessory nerve : Technical note with potential application in patients with high cervical quadriplegia. In: Child's Nervous System. 2008 ; Vol. 24, No. 11. pp. 1341-1344.
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T2 - Technical note with potential application in patients with high cervical quadriplegia

AU - Tubbs, R. Shane

AU - Pearson, Blake

AU - Loukas, Marios

AU - Shokouhi, Ghaffar

AU - Mohajel Shoja, Mohammadali

AU - Oakes, W. Jerry

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N2 - Introduction: High cervical quadriplegia is associated with high morbidity and mortality. Artificial respiration in these patients carries significant long-term risks such as infection, atelectasis, and respiratory failure. As phrenic nerve pacing has been proven to free many of these patients from ventilatory dependency, we hypothesized that neurotization of the phrenic nerve with the spinal accessory nerve (SAN) may offer one potential alternative to phrenic nerve stimulation via pacing and may be more efficacious and longer lasting without the complications of an implantable device. Materials and methods: Ten cadavers (20 sides) underwent exposure of the cervical phrenic nerve and the SAN in the posterior cervical triangle. The SAN was split into anterior and posterior halves and the anterior half transposed to the ipsilateral phrenic nerve as it crossed the anterior scalene muscle. Results: The mean distance between the cervical phrenic nerve and the SAN in the posterior cervical triangle was 2.5 cm proximally, 4 cm at a midpoint, and 6 cm distally. The range for these measurements was 2 to 4 cm, 3.5 to 5 cm, and 4 to 8.5 cm, respectively. The mean excess length of SAN available after transposition to the more anteromedially placed phrenic nerve was 5 cm (range 4 to 6.5 cm). The mean diameter of these regional parts of the spinal accessory and phrenic nerves was 2 and 2.5 mm, respectively. No statistically significant difference was found for measurements between sides. Conclusions: To our knowledge, using the SAN for neurotization to the phrenic nerve for potential use in patients with spinal cord injury has not been previously explored. Following clinical trials, these data may provide a mechanism for self stimulation of the diaphragm and obviate phrenic nerve pacing in patients with high cervical quadriplegia. Our study found that such a maneuver is technically feasible in the cadaver.

AB - Introduction: High cervical quadriplegia is associated with high morbidity and mortality. Artificial respiration in these patients carries significant long-term risks such as infection, atelectasis, and respiratory failure. As phrenic nerve pacing has been proven to free many of these patients from ventilatory dependency, we hypothesized that neurotization of the phrenic nerve with the spinal accessory nerve (SAN) may offer one potential alternative to phrenic nerve stimulation via pacing and may be more efficacious and longer lasting without the complications of an implantable device. Materials and methods: Ten cadavers (20 sides) underwent exposure of the cervical phrenic nerve and the SAN in the posterior cervical triangle. The SAN was split into anterior and posterior halves and the anterior half transposed to the ipsilateral phrenic nerve as it crossed the anterior scalene muscle. Results: The mean distance between the cervical phrenic nerve and the SAN in the posterior cervical triangle was 2.5 cm proximally, 4 cm at a midpoint, and 6 cm distally. The range for these measurements was 2 to 4 cm, 3.5 to 5 cm, and 4 to 8.5 cm, respectively. The mean excess length of SAN available after transposition to the more anteromedially placed phrenic nerve was 5 cm (range 4 to 6.5 cm). The mean diameter of these regional parts of the spinal accessory and phrenic nerves was 2 and 2.5 mm, respectively. No statistically significant difference was found for measurements between sides. Conclusions: To our knowledge, using the SAN for neurotization to the phrenic nerve for potential use in patients with spinal cord injury has not been previously explored. Following clinical trials, these data may provide a mechanism for self stimulation of the diaphragm and obviate phrenic nerve pacing in patients with high cervical quadriplegia. Our study found that such a maneuver is technically feasible in the cadaver.

KW - Anatomy

KW - Diaphragm

KW - Neurotization

KW - Spinal cord injury

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