Late return of diaphragm function in a ventilator-dependent patient with a high cervical tetraplegia: Case report, and interactive review

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Article presents case study of an individual with ventilator-dependent high cervical tetraplegia who was maintained on a ventilator for five years after sustaining a C3-C4 vertebral fracture with a complete high cervical tetraplegia. Diaphragmatic fluoroscopic evaluation at the initial injury revealed a non functioning diaphragm, and the patient was subsequently discharged home on a portable ventilator. Respiratory evaluation 5 years post injury, including diaphragmatic fluoroscopy, transcutaneous phrenic nerve conduction studies, and pulmonary function tests, revealed intact phrenic nerve function bilaterally with spontaneous diaphragmatic motion. Ventilator use was weaned and diaphragmatic muscle strengthening was achieved. This case report emphasizes the importance of re-evaluation of respiratory function and in particular, phrenic nerve viability and diaphragm function in patients with high cervical tetraplegia in light of potential neurologic recovery.

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