Promising Study Investigates EMG Assessment and Surgical Treatment of Phrenic Nerve Injury

Long-Term Assessment of Reconstruction Indicates Functional Correction and Symptomatic Relief

JFK Johnson Rehabilitation Institute and the Center for Treatment of Paralysis and Reconstructive Surgery published results of a study evaluating phrenic nerve integrity via electromyography (EMG) and reconstruction as an alternative to diaphragm plication.

Improved Breathing Function in Patients with Chronic Diaphragmatic Paralysis
The study followed 180 patients (134 males and 46 females, average age of 56) treated with phrenic nerve reconstruction for chronic diaphragmatic paralysis for a median 2.7 years. Eighty-nine percent of patients reported an improvement in breathing function.

The study, titled “Long-Term Follow-Up after Phrenic Nerve Reconstruction for Diaphragmatic Paralysis: A Review of 180 Patients,” was a follow-up to a 2013 study of functional restoration of diaphragmatic paralysis.

Long-Term Assessment of Phrenic Nerve Integrity
As background, injury to one phrenic nerve leads to paralysis of the ipsilateral diaphragm, often leading to symptoms of dyspnea, which may improve with time. If both phrenic nerves are injured, however, both diaphragms are affected and, if the injury is complete, usually results in ventilator dependency.

While difficult to determine the incidence of injury to the neuromuscular pathways that control the diaphragm, it is estimated that phrenic nerve injury occurs in up to 10 percent of the estimated 250,000 patients undergoing cardiac procedures each year in the United States. Furthermore, up to 75 percent of the roughly 6,000 new cervical spinal cord injuries per year in the U.S. experience diaphragmatic paralysis leading to chronic ventilatory support, which increases morbidity and mortality.

“It is significant that long-term assessment of phrenic nerve integrity via EMG and reconstruction for diaphragmatic paralysis suggests functional correction and symptomatic relief,” said David Brown, D.O., physical medicine and rehabilitation physician at Hackensack Meridian JFK Johnson Rehabilitation Institute, who is one of the authors of the study.

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