Dr. Matthew Kaufman has Performed
Nearly 70 Successful Phrenic Nerve Surgeries, and Counting!*
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.
The phrenic nerve transmits signals from the brain and spinal cord that may be initiated voluntarily or involuntarily – our breathing may occur when we think “breathe”, or without thinking breathing occurs when we are sleeping.
Injuries to the phrenic nerve can occur from surgery in the neck and chest, such as: coronary bypass surgery (CABG), neck dissection for head and neck cancer, surgery of the lungs, heart valve surgery, surgery of the aorta, thymus gland surgery, carotid-subclavian bypass surgery, and surgery for thoracic outlet syndrome.
Other causes of phrenic nerve injury include: epidural injections, interscalene nerve blocks, injuries related to a fall or accident, and even chiropractic manipulation of the neck.
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. If you or a loved one suffers from phrenic nerve injury, it is likely you have been told by your physician that you must learn to live with this deficit. It is also very likely that your level of activity has been significantly reduced due to diaphragm paralysis, resulting in chronic shortness of breath, sleep disturbances, and lower energy levels.
Nerve decompression and nerve transplants are commonplace in the treatment of arm or leg paralysis, and can restore function to a previously paralyzed muscle or group of muscles. At the Institute for Advanced Reconstruction, in New Jersey, our physicians have pioneered world-class treatment for phrenic nerve injury in order to reverse the diaphragm paralysis. We have performed close to twenty phrenic nerve decompressions and phrenic nerve transplants for the treatment of phrenic nerve injuries, and have been successful at reversing diaphragm paralysis in the vast majority of those treated.
We now receive requests for treatment both nationally and internationally, and routinely have patients visiting us from far away locations. Correspondence with patients following their phrenic nerve surgery has indicated significant improvements in physical functioning, such as regaining the ability to exercise. In addition, many patients report a reversal of sleeping difficulties related to the diaphragm paralysis.
Obviously, there is no guarantee that we will be able to offer you surgery, or that surgery will absolutely cure your phrenic nerve injury. However, we invite you to contact us so that we may arrange a phone discussion with one of our patient coordinators to discuss the circumstances of your phrenic nerve injury and diaphragm paralysis, and determine if you may be a candidate.
Dr. Matthew Kaufman is an award-winning cosmetic and reconstructive plastic surgeon, board certified in both Plastic Surgery and Otolaryngology-Head and Neck Surgery, and he is a Fellow of the American College of Surgeons (FACS). Dr. Kaufman embarked on his surgical training at one of the nation’s top training programs for Otolaryngology – Head and Neck Surgery at The Mount Sinai Hospital in Manhattan. He continued his training in Plastic and Reconstructive Surgery at the prestigious UCLA Medical Center in Los Angeles. Among his nerve surgery expertise which he performs together with his partners at the Institute for Advanced Reconstruction in Shrewsbury, NJ, Dr. Kaufman is the only known surgeon to perform specialized phrenic nerve surgery. As of October, 2011, Australia will be his furthest patient; 11 is the youngest he has operated on for phrenic nerve problems, and early 70s the oldest.
Q: How much of your practice is devoted to phrenic nerve surgery?
Approximately forty percent and growing. Each case requires a lot of time. In addition to the actual procedure, there is extensive pre-surgery preparation since most of the patients are from out of town. There’s a tremendous amount of time that goes into preparing each one. To fly across the country, or from someplace else in the world, and have a unique surgery is overall quite complicated.
Q: How common is phrenic nerve injury and what are its causes?
It’s probably more common than most people think, but hard to know. For example, what percentage of those with this problem is finding us at The Institute for Advanced Reconstruction?
I think there are some standard causes. If you break it down into broad categories you have a surgical injury (i.e. damage to the nerve while being operated on for other causes), an anesthetic injury (e.g. inadvertent damage by a needle passed into the neck), a manipulation injury (e.g. chiropractic), or some type of trauma (such as a fall from a horse, a car accident, or even a freak twisting the wrong way).
Q: What are the various factors among those requiring this procedure?
Age is a big factor for recovery; young patients regenerate better than older ones. Among our patients, the 25-40-year-olds do much better than the 50-70-year-olds in terms of recovery.
Two-thirds to three-four of the patients are men. Men have more injuries in general—so they undergo more surgery, and chiropractic, and more likely to get injured from it. Secondly, men are usually bigger and heavier—so if the neck and (big, heavy) arm twist, there is potentially more damage.
Q: How long have you been doing these surgeries, and do you consider 40 a landmark number of procedures?
I think that 40 is a lot for any procedure that’s never been done. I’ve been doing these surgeries since 2007, with the majority of them in the last year and a half. I specialized in phrenic nerve problems by accident. Our website was continually attracting patients with various rare nerve problems. I was challenged to figure out if I could do something for those with phrenic nerve problems requiring surgery.
It falls within my specialties—head and neck, and plastic surgery. The phrenic nerve is not commonly dealt with, unless it is neck or chest surgery, so thoracic or otolaryngology surgeons will encounter the phrenic nerve—but basically just to try to stay away from it. Until now, no one has attempted to actually get to the phrenic nerve—unless they inadvertently harm it– to do something positive with it.
I see the procedures I’ve done are just the tip of the iceberg. I still think the majority of the medical community that takes care of phrenic nerve injury patients has no idea yet, so the goal is to get the word out.
Q: How do you intend to spread the word of your work?
After our recent article in the CHEST Journal* and a well-received seminar in Hawaii**, I hope to expand my “doctor to doctor” outreach so that the medical community can become more familiar and comfortable with our treatment approach. It can be difficult to reach physicians, but now we are getting to more of them.
Q: How is your success rate with phrenic nerve surgery?
I’ve had a 70-80% percent success rate, which is consistent with other nerve surgeries that have been around for years. No one has 100 percent success. We don’t know enough about the nervous system to be able to surgically achieve that kind of success rate. While we’ve had a remarkable number of positive life-changing results with phrenic nerve cases, we’ve had patients who’ve not gotten better, and those we are waiting on over time, and we don’t know what their ultimate success will be. It can take a long time.
I always want to make procedures better. You always aim for 100 percent success; obviously, no one gets that. That being said, full function (of the phrenic nerve) is the goal I hope for. But if someone gets even 50 percent improvement, his or her life is going to be better.
Over time, I’ve learned a tremendous amount. I have a better understanding of how the nerve functions, and how it gets damaged. So with each case, the success rates are going to get higher.
Q: How do you determine your success rate?
Other than the patient telling you they feel better, there are really only several tests you can do. One would be a study of the nerves, but no one wants to come back and get needles stuck into them for this purpose; another is an x-ray to look for motion in the diaphragm, and the third is breathing tests–pulmonary function tests–which don’t always coordinate with patients’ symptoms. Pulmonary rehab is also an important part of the recuperative process that can help improve outcomes.
Q: How have you been impacted by the psychological or emotional aspect of doing this procedure over time?
I’m more in tune with the emotional aspect, since previously I never fully realized the implications of this condition in someone’s life, and quality of life. Most physicians still believe phrenic nerve injury is a relatively minor problem and that most people can live with, and that they don’t necessarily need to be treated for it. But my patients have taught me otherwise. That’s what we’re trying to teach the medical community.
Q: What can the patient do to help his/her odds?
If patients have this surgery they have to exercise the muscle (diaphragm). There are two things that are damaged: the nerve and the muscle. We’re only treating the nerve. I can’t make the muscle better. The muscle has to rebuild itself by exercise, usually through a pulmonary rehabilitation program.
Q: Is every case different both physically and, psychologically?
Yes, each case is different. It’s never cookie-cutter. It’s not like gallbladder surgery. It keeps me on my toes. We always have a standard game plan going into surgery, but I never completely know what I’m going to find until I go in– for example, if a person will need an actual nerve transplant– or what the outcome is going to be. It’s hard to prepare patients; that’s why I tell them all scenarios, and proceed with cautious optimism. We also turn away a lot of people. Just last week I turned a man away. Although he is very symptomatic, he had inconsistent results on tests we require. His tests show motion in his diaphragm, so I’m not going to take a person with a functioning diaphragm into surgery. I’ve probably turned away as many patients as I’ve operated on.
Q: Do you get ‘performance anxiety’ before doing these surgeries?
I wouldn’t say anxiety, but you get your “game face” on; you get into the zone. You have to plan, think, prepare. One of my mentors said, you have to do three things for surgery: study it, know what you’re going to do; envision the entire process in your head; finally, realize that process.
*Reinnervation of the Paralyzed Diaphragm: Application of Nerve Surgery Techniques Following Unilateral Phrenic Nerve Injury
Read more on Phrenic Nerve Surgery in our patient stories: