UF surgeons first in state to implant diaphragm pacing system in spine-injured patient

University of Florida surgeons today were the first in the state to implant an electronic breathing device in a ventilator-dependent, spinal cord-injured patient. The lightweight, battery-powered diaphragm pacing system was approved by the FDA last year and is designed to help spinal cord-injured patients breathe without external assistance.

The UF College of Medicine team used the NeuRx DPS developed by Synapse Biomedical, Inc. It is the same system that gave actor Christopher Reeve freedom from a ventilator after paralysis following a traumatic spinal cord injury.

Lawrence Lottenberg, M.D. (center) and neurosurgeon R. Patrick Jacob, M.D., were assisted by surgeon Raymond Onders, M.D. (left), from University Hospitals Case Medical Center in Ohio.

Trauma surgeons Lawrence Lottenberg, M.D. (center) and John Armstrong, M.D. were instructed by surgeon Raymond Onders, M.D. (left) from University Hospitals Case Medical Center in Ohio. Photo by Sarah Kiewel

UF trauma medical director Lawrence Lottenberg, M.D., and trauma surgeon John Armstrong, M.D., were instructed by surgeon Raymond Onders, M.D., from University Hospitals Case Medical Center in Ohio. Onders pioneered and used the then-experimental device in Reeve’s 2003 procedure.

“Today marks a major breakthrough,” said Lottenberg, who led the UF surgical team. “Though the procedure is straightforward, the possibility that it can partially or completely liberate someone who is otherwise 100 percent dependent on a ventilator to sustain life is of monumental significance.”

Lottenberg, Shands at UF Level I Trauma Center medical director, was the attending trauma surgeon on Jan. 2, when 27-year-old Chris Crosby of Lake Butler, Fla., arrived. Crosby had sustained a traumatic upper-cervical spinal cord injury that immediately paralyzed him from the neck down.

After receiving critical care from the trauma center’s multi-disciplinary experts, Crosby has spent weeks in the Neuro Intensive Care Unit being treated by UF neurosurgeon R. Patrick Jacob, M.D., and a team of specially trained, critical care UF physicians and Shands nurses.

Jacob said diaphragmatic pacing is the best-available option for many ventilator-dependent patients with traumatic injury to their upper spinal cord.

Lawrence Lottenberg, M.D. (center), and neurosurgeon R. Patrick Jacob, M.D. (right)

Lawrence Lottenberg, M.D. (center), and neurosurgeon R. Patrick Jacob, M.D. (right). Photo by Sarah Kiewel

“Our ultimate goal is to help decrease the patient’s reliance on a ventilator in order to help reintegrate him back into his own home and community,” Jacob said. “Even in the face of paralysis, freeing him and his caregivers from the costly and restricting ventilator will bring us one step closer to giving him some part of his life back.”

In a minimally invasive, laparoscopic procedure, surgeons implant the device to provide electrical stimulation to the muscle and nerves of the diaphragm, the major muscle involved in breathing. Powered by an external battery pack, the DPS prompts the diaphragm to contract. This allows the patient to breathe more naturally than with a ventilator, which forces air into the lungs.

Continuous ventilator assistance increases a patient’s risk for secondary complications, such as pneumonia. Ventilator-dependent patients cannot be transferred to rehabilitation facilities and must remain hospitalized. The DPS system, therefore, offers patients more portability/transfer options and less costly healthcare. Ventilator removal also allows patients to regain their sense of smell and taste and enables them to speak more easily.

The UF team will monitor Crosby’s recovery from today’s procedure in the hope that they can remove him from external ventilation. This could occur within one to several weeks, depending on Crosby’s recovery. After that occurs, he will begin rehabilitation treatment.

A formerly active youth highly involved in his community, Crosby said he wants this procedure to offer greater independence – not only for himself but also for other ventilator-dependent patients throughout Florida.

“I would like to thank Drs. Lottenberg and Jacob and Shands at UF for making a procedure like this possible in the state of Florida,” said Patricia Crosby, the patient’s mother. “We have been praying for miracles along the way and this is just one small one. Enabling Chris to be able to return to a more active lifestyle off a ventilator will be tremendous.”

Lottenberg said the newly trained UF team hopes to use the DPS on more patients in the future.

“There are about 200 Floridians on the brain and spinal cord central registry annually who rely on ventilators,” he said. “They could benefit from this procedure in the future. Diaphragmatic pacing can give them the chance to resume a more ‘normal’ and independent life.”