St. Joseph’s is proud to offer the NeuRx Diaphragm Pacing System™ for those with spinal cord injuries (SCI) and ALS. The NeuRx Diaphragm Pacing System™ (DPS) is a neurostimulation technology designed to:
- Decrease reliance on a ventilator.
- Increase day-to-day independence.
With no moving parts, noiseless operation and small size, the DPS enhances mobility and transportation options, and in patients with SCI, can even return a sense of taste and smell.
What happens when I breathe?
When you breathe, oxygen is brought into the lungs and absorbed into your veins. The veins carry the oxygen to your heart, which pumps it through your arteries so that it can nourish your organs and tissues. At the same time, carbon dioxide is taken out of your veins by the lungs and removed from your body when you exhale.
What is the diaphragm and how does it work in breathing?
The diaphragm is the body’s most important breathing muscle. It is a sheet of muscle that separates your abdomen from your chest. When you breathe in, the phrenic nerves cause the diaphragm to push down into your abdomen. This creates more space for your lungs to expand as air rushes in. At the same time, the muscles between your ribs cause your ribcage to expand and move upward.
How do ALS and SCI affect breathing?
Patients with high-level SCI typically experience chronic breathing problems primarily due to diaphragm muscle paralysis. Because of this, SCI patients have typically been supported through positive pressure mechanical ventilation.
With ALS, your nerves’ ability to signal your muscles decreases over time. This also affects your breathing nerves (phrenic nerves), which lose their ability to carry the message from your brain to your diaphragm. Ultimately, ALS weakens your diaphragm. As your diaphragm weakens, you develop a condition called chronic hypoventilation, which means you’re no longer drawing enough oxygen into your lungs.
Should I wait until I notice my breathing is difficult?
No. Waiting too long will result in loss of nerves and muscle response past the point of treatment being an option. Based on published data, muscle weakness from nerve loss will begin and progress before you notice breathing problems and complications.
Am I a candidate?
To determine if the NeuRx DPS® is right for you, you will undergo a multidisciplinary evaluation from a thoracic surgeon, pulmonologist and a neurologist all in the same day. As part of the evaluation, the medical team has to determine if your diaphragm will respond to electrical stimulation. Your phrenic nerve function is tested by either:
- Visualizing diaphragm contraction with fluoroscopy (SNIF).
- Radiographic techniques (such as ultrasound).
- Neurophysiological testing (phrenic nerve EMG).
Blood tests may also be completed. Our physicians will go over any tests with you.
How is the DPS implanted?
A simple, minimally invasive outpatient procedure is used to implant the device’s four biocompatible electrodes, two in each side of your diaphragm. The fifth electrode is placed just below the skin near the exit site of the other electrodes. Only a few stitches are needed to close the small incisions. The entire procedure lasts approximately 90 minutes. You may feel sore after your surgery, as your body heals.
What are the risks of implantation surgery?
A clinical study has demonstrated the DPS treatment and use is safe when used according to directions. The most commonly reported adverse event related to CO2 migration called capnothorax was easily managed operatively. The physicians at St. Joseph’s will go over risks in detail with you before surgery.
To learn more about NeuRx DPS®, please call our office at 602-406-6274.
Watch the Video
The video below shows the pacing system in a patient with ALS. The electrical stimulation exercises the diaphragm, much like physical therapy for arms or legs.
Warning: the video below shows a live surgery and may be unsuitable for certain audiences.