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Four electrodes are places on the diaphragm using a minimally invasive laproscopic technique. The electrodes are controlled by the NeuRX DPS™ and the NeuRX Clinical Station™

February 13, 2006 – Research Article: Breathing Easier

By: Shannon Passon

It’s been nearly a decade since Dr. Raymond Onders began working on a device that could improve the quality of lives of ventilator dependent patients as a result of spinal cord injuries. Today, not only is the procedure a reality, but it may be coming to Shepherd Center.

The device is an implant called a diaphragm pacing system (DPS) that stimulates the diaphragm and allows patients to come off of a respirator over time with less risk. Right now, there's only one place patients can undergo this procedure, but a partnership with Shepherd Center is on the way and availablility may be just months away.

Dr. Onders, Director of Minimally Invasive Surgery at University Hospitals of Cleveland in Ohio and Associate Professor of Surgery at Case Western Reserve University has performed twenty-two of the procedures with a 95 percent success rate.

The late actor Christopher Reeve was Dr. Onders' first success story. Reeve received the implant with very good results. At the time, Dr. Onders says, Reeve was taking a chance on a pioneering procedure, but he bravely went forward and was rewarded with decreased dependence on his ventilator.

The surgical procedure can be performed on an outpatient basis. The surgeon goes in laparoscopically and places electrodes directly onto the diaphragm to stimulate the muscle at a set rate of 10-12 times per minute. The tracheostomy is capped off. Wires attached to the electrodes are run to an external battery pack. The patient can discontinue use of the implant at any time by disconnecting the wires. As the diaphragm gets stronger, the patients is able to breath independently again for varying periods of time.

Having a reliable and responsible caregiver is essential for consideration. Potential patients and their caregivers must be willing and able to follow post-operative instructions and return to the clinic for regular follow up visits. Since this is an experimental investigational procedure, surgery and follow up care may not be covered by insurance.

It appears that patients with a C3 or C4 spinal cord injury are among the best candidates for the implant. The injury is between the must be above the upper respiratory system and the. The patient's intact phrenic nerve, the major nerve supply to the diaphragm., must be intact. A test is performed to determine whether the phrenic nerve is viable before proceeding with the surgery.

An advantage of this diaphragm stimulation procedure is the ability to perform it as soon as a patient is stabilized post injury. Patients may adjust to the device immediately, before muscles have a chance to atrophy. This may heighten the chance of a smooth transition to the diaphragm pacer and, in turn, increases the chance of returning to independent respiration sooner.

Dr. Onders says beyond the physical benefits of the procedure, there are psychological benefits as well. The biggest of those is freedom. The implant gives patients the ability to more easily engage in normal activities.

The implant may also save patients health care costs associated with long term ventilator dependence. The average cost of maintaining a ventilator is $120,000 per year.

One of the more surprising advantages of the device was revealed during the notorious 2005 hurricane season, particularly during Hurricane Katrina. In a dire situation like being in the path of a looming hurricane, it's more important than ever to know that a person can depend on the power supply to a ventilator. With power questionable at times, patients caught in the storm's shadow were forced to make a difficult decision: leave the storm area days early or risk power outages and dependence on a ventilator battery that lasts a mere six hours. This is where the diaphragm stimulator has the clear advantage. With batteries that last weeks, the implant gives patients a greater sense of calm and control in an otherwise out of control hurricane emergency. In the course of the season, a few patients opted for the implant and were better able to deal with difficult circumstances, in one patient's case, the loss of a home.

Dr. Onders is currently performing one or two of the implant surgeries every week - sometimes in patients 20 years post injury.

Diaphragm pacing system technology has many other potential uses now being explored. Applications include new options for patients struggling with Ondine's Disease, which is a birth defect that impairs involuntary respiration during sleep. Another application is in extending quality of life for patients suffering from Lou Gehrig's disease. The procedure has already been successfully performed on ALS patients.

As for future availability for patients at Shepherd Center, the first patients to receive DPS implants may have just a matter of months to wait.