A preliminary evaluation of the surgery to reconstruct thoracic breathing in patients with high cervical spinal cord injury

Study design: A prospective study. Objectives: To evaluate the effect of the surgery to reconstruct thoracic breathing in patients with high cervical spinal cord injury (CSCI). Setting: China Rehabilitation Research Center, Beijing, China. Methods: The posterior ribs (from the fifth to the eighth) were suspended on the inferior angle of the scapula on each side using titanium cables, as well as muscles and myofascial tissue in the subscapular area. After the surgery, the patients were trained for synchronous contraction of the trapezius and diaphragm muscles, and electromyography (EMG) was performed to evaluate the synchronization. The clinical symptoms and pulmonary function were assessed within 1 week before surgery and at 2, 12 and 24 postoperative weeks. Results: Six patients with complete high CSCI received rib suspension surgery 84 +/- 26.7 days after spinal cord injury. Before the surgery, all of the patients presented with weakened cough, retention of respiratory secretions and dyspnea, while these symptoms alleviated postoperatively. The vital capacity (VC) was enhanced to be 1680 +/- 282 ml at 2 weeks after the surgery, compared with 1085 +/- 92 ml (P = 0.013). The EMG showed a synchronous muscle electrical activity between the trapezius muscles and diaphragm during deep breaths. Conclusion: The rib suspension surgery partially restored the thoracic breathing of the patients with high CSCI, thereby improving VC, cough and expectoration.