May 21st, 2015
Drs. Matthew Kaufman and Andrew Elkwood were published in the Journal of Reconstructive Microsurgery in a study entitled Diaphragmatic Reinnervation in Ventilator-Dependent Patients with Cervical Spinal Cord Injury and Concomitant Phrenic Nerve Lesions Using Simultaneous Nerve Transfers and Implantable Neurostimulators. The study examines the outcomes of ventilator-dependent patients patients who underwent simultaneous microsurgical nerve transfers and the implantation of diaphragmatic pacemakers.
The content of the study is perhaps best summarized in a recent patient story of Andrew Brown, who suffered a spinal cord injury that forced him to rely on mechanical ventilation for respiratory function. After undergoing the simultaneous nerve transfer and diaphragmatic pacemaker implantation procedure, Brown has reduced his ventilator requirements and Dr. Kaufman hopes to see him eventually breathe on his own.
May 11th, 2015
In August 2012, Andrew Brown was on his way home from seeing his young son in the hospital for a surgical procedure when his life was forever changed. Brown was involved in an automobile accident, leaving him paralyzed from the neck down.
Subsequently, he had enormous difficulty breathing, often requiring mechanical ventilation, which put him in the hospital every month last year. In fact, in January 2014, his mother Gloria reports, “The doctor didn’t expect him to live.”
Paralysis can impact the transmission of nerve impulses that control breathing as a consequence of damage to the spinal cord and phrenic nerves. The phrenic nerves control function of the diaphragm muscle – the primary muscle involved in breathing.
On December 5, 2014, Brown underwent surgery with Dr. Matthew Kaufman and Dr. Andrew Elkwood, both of The Institute for Advanced Reconstruction in Shrewsbury, NJ, and Dr. Adam Shiroff, Chief of Trauma Surgery, at Jersey Shore University Medical Center in Neptune, NJ. Dr. Kaufman, the only known surgeon to perform surgery on the phrenic nerve, completed a phrenic nerve graft while installing a diaphragm pacemaker with Dr. Shiroff. Dr. Elkwood, one of few experts worldwide doing certain specialized microsurgery procedures, did tendon transfers to Brown’s right arm, which is permanently bent at a 45-degree angle.
About three months later, Brown could feel a change. “We are thrilled that he has already reduced his ventilator requirements substantially. As the phrenic nerve regenerates over a period of one year and the diaphragm muscle strengthens, we would not be surprised if he is eventually able to breathe completely on his own,” states Dr. Kaufman. In addition, Dr. Elkwood’s procedure has resulted in movement in Brown’s right thumb.
There was a time when Andrew Brown couldn’t even sit up in his wheelchair and had to spend most of his time reclining. Today, the 34-year-old Lacy Springs, Alabama, resident breathes freely with the aid of his pacemaker and spends so much time powering his wheelchair that the battery runs out.
“This was life-changing surgery,” states Andrew Brown. “But I’m still hoping for further improvement.” His goal is to regain the use of his arm and to breathe without the pacemaker.
An article by Drs. Kaufman, Elkwood and others titled “Diaphragmatic Reinnervation in Ventilator-Dependent Patients with Cervical Spinal Cord Injury…” was published in April 2015 in the Journal of Reconstructive Microsurgery. Among those studied, it was concluded that “Recovery of diaphragm electromyographic activity was demonstrated in 13 of 14 (93%) patients.” Andrew Brown has also benefited from these advanced surgical techniques.
Dr. Kaufman will be presenting on the Evaluation Of Current And Future Surgical Treatment Options for Diaphragmatic Paralysis and Ventilator Dependency in High Cervical Tetraplegia at the May 14-16, 2015 ISCOS ASIA meeting in Montreal, the largest international scientific gathering of experts in the treatment of spinal cord injury.
September 3rd, 2014
Gal Cohen*, who was used to a regular, brisk swim, found that following a surgical procedure for an unrelated issue, he was so short of breath he could barely manage. He couldn’t sleep on his left side and used bedroom fans to provide what he felt was missing oxygen. In general, says the Tel Aviv resident, “I felt like I was suffocating even with mild exertion.”
Subsequent tests determined he had reduced lung function and a chest radiograph (type of x-ray) showed an elevated right diaphragm, evidence of his abnormal lung function and breathing problems.
The surgeon who operated on him told him that the surgery went well and that no nerve was mistakenly cut, and that nerve regeneration would on its own lead to recovery; however, two years later the problem was still not resolved. That’s when Cohen found reconstructive plastic surgeon Dr. Matthew Kaufman via the Internet.
Dr. Kaufman continually sees patients like Gal Cohen, who have a paralyzed diaphragm as a result of surgery, injury or accident. Subsequently, they have life-altering symptoms. Much of the time, these patients are told by other medical professionals that they “just have to live with it.” But the condition can cause severe problems, such as dangerous, repeated bouts of pneumonia. Dr. Kaufman offers an alternative. He is the only known surgeon to perform specialized phrenic nerve surgery. Dr. Kaufman, a specialist in Otolaryngology (head and neck surgery) has patients of all ages who have had phrenic nerve surgery and have come from around the U.S. and the world, including, Australia, Canada, and Israel.
Dr. Kaufman has performed this procedure, which he does at Jersey Shore University Medical Center in New Jersey and at the University of California at Los Angeles (UCLA) Medical Center, over 150 times since 2007. He has also published various academic articles on phrenic nerve surgery.
The phrenic nerve controls function of the diaphragm muscle – the primary muscle involved in breathing. Contraction of the diaphragm muscle permits expansion of the chest cavity and inhalation of air into the lungs. Until now, treatment options for phrenic nerve injury have been limited to either nonsurgical therapy or diaphragm plication, neither of which attempts to restore normal function to the paralyzed diaphragm.
Advances in nerve decompression and transplant have enabled Dr. Kaufman to reverse diaphragm paralysis. The techniques he utilizes are derived from the procedures commonly used to treat arm or leg paralysis, which have allowed surgeons to restore function to previously paralyzed muscle groups.
In July 2014, a year following surgery with Dr. Kaufman, Gal Cohen reported that his
quality of life had improved significantly. He sleeps normally and has done away with his bedroom fans. “I have my energy back and no longer feel limited. I am capable of functioning without heart palpitations and shortness of breath,” he says. Furthermore, a chest fluoroscopy (an x-ray that evaluates diaphragm movement), performed a year after surgery, revealed movement on both sides.
Dr. Kaufman states, “We have been very pleased with the progress of diaphragm recovery in this patient who traveled a long way (from Israel) to entrust us with his care. He suffered a rather severe injury to his phrenic nerve that would have otherwise left him with a permanent breathing deficit. Advanced microsurgical nerve techniques have been utilized for his specific injury leading to tremendous improvements. We expect further recovery over the next one to two years commensurate with ongoing muscle reactivation.”
Gal Cohen, now a 48-year-old Ph.D. in genetics, says that since the surgery, “I can swim one kilometer (0.62 mile) in 25 minutes or less without difficulty. I actually feel almost the same as before the diaphragm injury. I’m so glad I found Dr. Kaufman.”
*Not the patient’s real name
May 20th, 2014
On March 27th, 2012, Kevin Neary underwent surgery with Dr. Matthew Kaufman in an effort to salvage his phrenic nerve and install a pacemaker to get his diaphragm working. The 29-year-old graduate of the University of Pennsylvania had been on a ventilator since Nov. 15, when he was shot during an attempted robbery in Northern Liberties and left quadriplegic. Doctors thought that the damage from the bullet, which was still lodged in his neck, had impaired the phrenic nerve, which triggers the diaphragm and allows the lungs to draw in air. He was hopeful that this procedure would get him off the ventilator for six hours per day.
In a recent video that Kevin sent in shows that he is almost 100% off the ventilator and breathing on his own.
May 13th, 2014
Nick Andrade was a 17-year-old competitive swimmer when he took a vacation trip to his Brazil, where he has relatives. It was there that Nick dove into shallow water and suffered a spinal cord injury, leaving him paralyzed from the neck down and on a ventilator.
Eventually, when he was told he would never be able to breathe on his own, forever connected to a ventilator, Nick did not want to go on; he had lost all hope. Ultimately, he was referred to Dr. Matthew Kaufman of The Institute for Advanced Reconstruction by Dr. Wise Young, director of the W.M. Keck Center for Collaborative Neuroscience and a professor at Rutgers University, New Jersey. In July 2013 Nick underwent specialized surgery with Dr. Kaufman, including nerve grafting and implantation of a breathing pacemaker device. Today, the now 19-year-old Charlotte, North Carolina resident is starting to breath on his own, and is weaning off the use of the ventilator. Dr. Kaufman has been performing these surgeries on spinal cord injured patients in both New Jersey and at the University of California Los Angeles for the past seven years. Currently, as Nick progresses, his physicians are in close contact with Dr. Kaufman and his team.
Breathing pacemakers provide respiratory function superior to mechanical ventilators since the inhaled air is drawn into the lungs by the diaphragm under negative pressure, rather than being forced into the chest under positive pressure. This is physiologically more accurate and comfortable for the patient.
Pacing patients are also at much lower risk of upper airway infections including ventilator-associated pneumonia (VAP). Breathing pacemakers are small, and do not require the bulky tubing and batteries of mechanical ventilators, so the patient’s mobility is greatly enhanced. Breathing pacemakers can be implanted using a variety of minimally-invasive surgical approaches.
Nick Andrade’s progress is the source of great personal joy for him and his family. According to the homepage of his website www.teamnickandrade.com, “Due in large part to the generosity & support of the community, Nicholas has made great strides in weaning off the ventilator. Now Nicholas is able to breathe for up to 3 hours on his own and we are hopeful that he will be off the ventilator before the summer.”
Making news, a new February, 2014 study published in the Journal of Trauma Acute Care Surgery finds that diaphragm pacing (DP) stimulation in spinal cord-injured patients is successful not only in weaning patients from mechanical ventilators but also in bridging patients to independent respiration, where they could breathe on their own without the aid of a ventilator or stimulation.
Dr. Matthew Kaufman has published numerous articles on this topic in the medical literature, and been a presenter at several national and international medical conferences, including more recently in Hawaii and in Vienna, Austria. On, Saturday, May 17th, Dr. Kaufman will present at the 40th annual American Spinal Injury Association (ASIA) 2014 Annual Scientific Meeting in San Antonio, Texas. His topic will be “Successful Reversal of Ventilator Dependency in Cervical Spinal Cord Injury and Stroke With Combined Upper Motor Neuron and Phrenic Nerve Lesions Using Simultaneous Nerve Transfers and Diaphragmatic Pacemakers.”