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Pacemaker helps spine injury patient breathe easy

Staff Reporter
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He was on ventilator for the last three months

Chairman of Kovai Medical Center and Hospital Nalla G. Palaniswami (centre), consultant neurosurgeon J.K.B.C. Parthiban (left) and neurologist Arulselvan (right) calling on B. Nachimuthu Gounder, who had been implanted a ‘pacemaker’ (Phrenic nerve stimulator) to treat respiratory insufficiency at the hospital, in Coimbatore on Thursday. —Photo: K. Ananthan
Chairman of Kovai Medical Center and Hospital Nalla G. Palaniswami (centre), consultant neurosurgeon J.K.B.C. Parthiban (left) and neurologist Arulselvan (right) calling on B. Nachimuthu Gounder, who had been implanted a ‘pacemaker’ (Phrenic nerve stimulator) to treat respiratory insufficiency at the hospital, in Coimbatore on Thursday. —Photo: K. Ananthan

When a heavy load fell on 65-year-old B. Nachimuthu Gounder’s head at his workplace at Palladam near here three months ago, it crushed his cervical spine (neck region) and the broken bones cut the spinal cord and immobilised him. And, he was not able to breathe normally because of damage to the brain stem.

For the last three months, he was on ventilator. Now, he can breathe easy for at least half the day without the ventilator. Doctors at Kovai Medical Center and Hospital in the city have put a pacemaker in him to enable this. The pacemaker is normally used for heart patients. The hospital had earlier used it in a Parkinson’s patient to control tremors. Explaining the case during a press conference on Thursday, J.K.B.C. Parthiban, consultant neurosurgeon of the hospital, said that the man met with the accident and was immediately administered first aid at a nearby hospital.

He was shifted to KMCH where CT (computed tomography) and MRI (magnetic resonance imaging) scans revealed that the C2 cervical vertebra had broken. The cervical vertebrae are numbered, with the first one (C1) being closest to the skull. The injury left him a quadriplegic (paralysed below the neck).

The neurosurgeon explained that the breathing was affected because of the injury to the brain stem that controls and passes through the spinal canal. The phrenic nerves that orginate from the cervical area were also affected. These nerves activate the diaphragm located between the thorax and abdomen. When an injury cuts the activation process, the diaphragm does not function to enable normal breathing.

Dr. Parthiban said they attended to the fractured neck bone first by fixing it with a screw through a spine surgery. This was followed by physiotherapy. After this, in order to relieve the patient from his three-month dependence on ventilator for breathing, the surgeon and his team decided to use a pacemaker. Electrodes were placed around the phrenic nerves in the neck on both sides and the pacemaker was placed in a pouch created on the chest wall. Once the pacemaker was activated, it stimulated the phrenic nerves and initiated the process of normal breathing at a steady rate.

“Within four weeks, the patient was able to breathe with the pacemaker for 12 hours a day, which was a significant improvement. The lithium battery of the pacemaker will last for at least 15 years, after which a minor surgery will be needed to replace them,” he added. Nalla G. Palaniswami, KMCH chairman, said actor Christopher Reeve sustained a cervical spine injury that paralysed him neck down. He went on to live for nine years with the help of ventilators.

Arulselvan (neurologist), Balasundaram (cardiothoracic surgeon), Rajendran (anaesthesiologist) and Sivakumar (intensivist) formed the team along with Dr. Parthiban.

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