Laparoscopic Diaphragmatic Pacing in Spinal Cord Injury Patients with Respiratory Failure: A Saudi Arabian Experience

Cervical spinal cord injury (SCI) carries a significant burden in Saudi Arabia, frequently resulting in permanent ventilator dependence and high morbidity. While laparoscopic diaphragmatic pacing (DP) has emerged as an alternative to long-term mechanical ventilation (MV) globally, regional evidence regarding its application within the Middle East remains limited. This study evaluates a single-center cohort of ventilator-dependent cervical SCI patients undergoing laparoscopic DP.

We conducted a retrospective analysis of all ventilator-dependent patients with cervical SCI admitted to a tertiary hospital in Riyadh between 2012 and 2024 who underwent laparoscopic DP after failing traditional weaning attempts. Inclusion criteria required at least 3 months of MV dependence, intraoperative diaphragmatic stimulability and a minimum one-year follow-up post-implantation. Across the entire cohort, the long-term follow-up duration reached a median of 60.0 months (interquartile range [IQR]: 36.0-84.0 months; range: 12.0-120.0 months).

Out of 30 initial candidates with cervical SCI, 28 patients (22 males, 6 females; median age 24.0 years (interquartile range [IQR]: 15.0-33.0 years)) were included. Patients had been on MV for a median of 13.0 months (IQR: 10.5-16.0 months) prior to the procedure. Utilizing a combined weaning success rate (complete or partial weaning), 26 patients (92.86%; 95% CI: 77.42-98.01%) were successfully transitioned to the pacing protocol, while 2 patients (7.14%) experienced DP failure. Complete (24 h) daily MV independence was achieved by 18 patients (64.29%), and partial weaning (≥4 h/day of MV-free time) was achieved by 8 patients (28.57%). Age at the time of injury ranged from 5 to 62 years. No major intraoperative or postoperative complications occurred. Minor exit-site skin irritation was observed in 3 patients (10.71%), all of which resolved completely with conservative local care alone without requiring antibiotic therapy.

In this selected single-center Saudi cohort of ventilator-dependent cervical SCI patients, laparoscopic DP was feasible and was associated with high rates of partial or complete ventilator-free breathing. Larger prospective multicenter studies with standardized selection criteria, safety reporting, respiratory outcomes, quality-of-life measures, and longer follow-up are needed.