Long-Term Follow-Up after Phrenic Nerve Reconstruction for Diaphragmatic Paralysis: A Review of 180 Patients

Abstract

Phrenic nerve reconstruction has been evaluated as a method of restoring functional activity and may be an effective alternative to diaphragm plication. Longer follow-up and a larger cohort for analysis are necessary to confirm the efficacy of this procedure for diaphragmatic paralysis. A total of 180 patients treated with phrenic nerve reconstruction for chronic diaphragmatic paralysis were followed for a median 2.7 years. Assessment parameters included: 36-Item Short Form Health Survey (SF-36) physical functioning survey, spirometry, chest fluoroscopy, electrodiagnostic evaluation, a five-item questionnaire to assess specific functional issues, and overall patient-reported outcome. Overall, 134 males and 46 females with an average age of 56 years (range: 10-79 years) were treated. Mean baseline percent predicted values for forced expiratory volume in 1 second, forced vital capacity, vital capacity, and total lung capacity, were 61, 63, 67, and 75%, respectively. The corresponding percent improvements in percent predicted values were: 11, 6, 9, and 13% ( ≤ 0.01; ≤ 0.01; ≤ 0.05; ≤ 0.01). Mean preoperative SF-36 physical functioning survey scores were 39%, and an improvement to 65% was demonstrated following surgery ( ≤ 0.0001). Nerve conduction latency, improved by an average 23% ( ≤ 0.005), and there was a corresponding 125% increase in diaphragm motor amplitude ( ≤ 0.0001). A total of 89% of patients reported an overall improvement in breathing function. Long-term assessment of phrenic nerve reconstruction for diaphragmatic paralysis indicates functional correction and symptomatic relief.

Iatrogenic phrenic nerve palsy

“…A further and larger study of 180 patients from the same authors following phrenic nerve reconstruction demonstrated an improvement in nerve conduction latency (average of 23%) and diaphragmatic motor amplitude (average of 125%) and well as 89% of patients reporting improvement in their breathing function (15). Median follow up time was 2.7 years.…”

“…They can be used to examine the amount and pattern of activation of the diaphragm. Diaphragmatic EMGs can be recorded using an intramuscular needle to measure the difference between the active electrode, which is placed at the lower end of the sternum, and an indifferent electrode, which is placed at the top of the sternum (11,15). Disadvantages of using EMGs are that they are difficult to perform and uncomfortable for the patient, and therefore are not widely used in patient work up.…”

Perioperative Diaphragm Dysfunction

“…While patients with morbid obesity or progressive neuromuscular diseases may require alternative approaches [106], plication shines in its ability to improve diaphragm function. However, for those seeking complete restoration of diaphragmatic movement, phrenic nerve reconstruction offers a targeted approach, directly addressing nerve damage and overcoming anatomical hurdles [107].…”

Results of the Diaphragmatic Plication Database: 10 Years' Experience

“…However, other surgical methods like phrenic nerve reconstruction or phrenic pacemaker implementation exhibit smaller complication rates than plication. 31,32 These are appropriate methods for a small subset of UDP patients with traumatic genesis and preserved electromyographic rest activity of the phrenic nerve. 33 It was the purpose of this study to demonstrate the ability of surgical diaphragmatic plication to improve the lung function and to identify the parameters which may serve for the design of future prospective studies on this topic.…”