Disclosures: Andrés E. Gutiérrez Robles, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 34-year-old man with C4 ASIA C incomplete quadriplegia

Case Description: Patient sustained a motor vehicle accident resulting in a C3 facet fracture with disc herniation at C3-C4 causing SC compression, leading to his quadriplegia on evaluation. He underwent emergent anterior cervical discectomy and fusion. The next day, he developed respiratory distress, needing re-intubation. On day 3 post-intubation, he was transferred to another facility for evaluation of diaphragmatic pacer (DP) implantation. On day 9, he underwent tracheostomy, percutaneous endoscopic gastrostomy tube and DP placement. Pacer trials were started immediately; he was able to be weaned from the ventilator to a 24-hour pacing system in a matter of 2 days. As a result, he was later admitted to our acute rehabilitation facility instead of an out-of-state rehabilitation facility with the capability of ventilator management.

Setting: Acute Spinal Cord (SC) Injury Rehabilitation Unit.Assessment/

Results: On admission to our inpatient unit, he presented as a C4 ASIA C quadriplegic although with slow neurological and functional recovery. He was discharged after 3 weeks at a total assist level although with improved speech and airway management capabilities. At 7 weeks post DP implantation, he was able to turn off pacer and breathe on his own with eventual removal of DP at the 16-week mark. 5 months post-injury, he has progressed to a C4 ASIA D quadriplegic and is able to transfer and ambulate 120 meters independently with a rolling walker.

Discussion: Chronic use of mechanical ventilation has been associated with extended hospital stays, pneumonia, diaphragmatic atrophy, and higher economic burden. In this case, we present how the early use of DP may benefit patients into earlier participation in acute inpatient rehabilitation in a facility closer to his home where his social support is.

Conclusion: Early use of DP should be considered more often in high-cord lesions for early participation in rehabilitation efforts.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/early-diaphragmatic-pacer-use-in-an-incomplete-quadriplegic-patient-a-case-report/