58-yr-old man breathes on his own after rare surgery at Pune hospital, six months on ventilator

Indian Express

03-05-2025

Ruby Hall Clinic in Pune has achieved a medical breakthrough with the successful performance of phrenic nerve neuromodulation surgery, claimed to be the first in Maharashtra, on a patient with a breathing problem. This rare and complex procedure has enabled a 58-year-old man to breathe independently after being dependent on a mechanical ventilator for six months due to a spinal cord injury.
This advanced surgical therapy stimulates the diaphragm, the major muscle required for breathing, and provides an essential solution for patients with neuromuscular weakness due to high cervical spinal cord injuries.
The surgery was performed on Sanjay Pai under the expert care of the Intensivist Dr Kapil Zirpe, head of the Neuro Trauma Unit at Ruby Hall Clinic, and performed by Dr Manish Baldia, consultant functional neurosurgeon.
Pai, who had suffered a high cervical spine injury (C3-C4 fracture) from a fall in his bathroom on July 25, 2024, was initially treated at another hospital. Despite undergoing C4 corpectomy, C3-C4 discectomy, and a range of spinal fusion surgeries, he remained quadriplegic and ventilator-dependent.
Imaging studies confirmed a C3-C4 anterior subluxation and spinal cord compression, though no acute brain changes were observed.
Pai was transferred to Ruby Hall Clinic on September 19, 2024, for further management, including neuro-monitoring, ventilator weaning support, and rehabilitation. He was conscious, oriented, on mechanical ventilation, and undergoing PEG (Percutaneous Endoscopic Gastrostomy) feeding and antibiotic therapy.
Aware of the serious risks posed by prolonged ventilator use, including ventilator-associated pneumonia, stress ulcers, deep vein thrombosis, and pulmonary embolism, the medical team comprising Dr Richa Singh, Dr Manish Baldia, Dr Zirpe with his ICU team, and Dr Grant chose to perform the phrenic nerve neuromodulation surgery.
Dr Baldia, who performed the surgery, said that initially, despite the efforts they were unable to wean him, but soon after phrenic nerve stimulation surgery, there was an improvement in his breathing.
This was a highly delicate and rare procedure in which they placed a small device near the phrenic nerve. With the help of this device, the doctors were able to activate and control Pai's diaphragm externally through a remote and initiate the process of ventilator weaning. They programmed the stimulator as per the patient's physiological response, gradually enhancing diaphragm strength without inducing fatigue.
'The success of this surgery provides a new hope for patients with severe spinal cord injuries and long-term ventilator dependence,' Dr Purvez Grant, chief cardiologist, managing trustee and chairman of Ruby Hall Clinic, said at a media conference on April 30.
Following the surgery, Pai showed excellent recovery. Gradually, his ventilator support was reduced, and by April 28, he was successfully shifted to the general ward for continued rehabilitation, the doctors said.