| Phrenic nerve conduction studies in spinal cord injury: applications for diaphragmatic pacing. | |
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MedLine Citation:
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PMID: 19016542 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The diaphragm pacing system (DPS) is a minimally invasive alternative to mechanical ventilation in patients with quadriplegia due to cervical myelopathy primarily caused by high cervical spinal cord injury. We evaluated 36 patients, 29 of whom had traumatic spinal cord injury, two who had a history of remote meningitis and demyelinating disease, and five who had cervical myelopathies of unknown etiology. Phrenic nerve conduction studies were performed with simultaneous fluoroscopic observation of diaphragm excursion to assess diaphragm viability. In the preoperative evaluation, diaphragm compound muscle action potentials (CMAPs) were recorded only when the diaphragm moved on fluoroscopy with ipsilateral stimulation. Twenty-six patients who were determined to have a viable diaphragm underwent DPS. Following DPS the primary outcome was the time (hours per day) that patients were able to pace and stay off the ventilator. Of 26 implanted patients, 96% (25 patients) were able to pace and tolerate being off the ventilator for more than 4 h per day. This study demonstrates that the presence of a diaphragm CMAP is associated with diaphragm movement observed by fluoroscopy in cervical myelopathy. In addition, DPS can help patients with cervical spinal cord injury to breathe unassisted by a ventilator. |
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Authors:
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Amer Alshekhlee; Raymond P Onders; Tanvir U Syed; Maryjo Elmo; Bashar Katirji |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Muscle & nerve Volume: 38 ISSN: 0148-639X ISO Abbreviation: Muscle Nerve Publication Date: 2008 Dec |
Date Detail:
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Created Date: 2008-11-25 Completed Date: 2009-01-29 Revised Date: 2009-11-10 |
Medline Journal Info:
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Nlm Unique ID: 7803146 Medline TA: Muscle Nerve Country: United States |
Other Details:
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Languages: eng Pagination: 1546-52 Citation Subset: IM |
Affiliation:
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Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio 44106, USA. amer.alsheklee@uhhospitals.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Action Potentials
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physiology Adult Diaphragm / physiology* Electric Stimulation Electrodiagnosis Female Fluoroscopy Humans Laparoscopy Male Middle Aged Motor Neurons / physiology Neural Conduction / physiology* Phrenic Nerve / physiology* Respiration, Artificial Spinal Cord Injuries / physiopathology* Survival Analysis Treatment Outcome |
| Comments/Corrections | |
Comment In:
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Muscle Nerve. 2009 Nov;40(5):904-5; author reply 905-6
[PMID:
19697381
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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