ArticleMedical sciences (Basel, Switzerland)2026
Laparoscopic Diaphragmatic Pacing in Spinal Cord Injury Patients with Respiratory Failure: A Saudi Arabian Experience.
Article in Medical sciences (Basel, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND/
objectivesCervical 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.
methodsWe 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).
resultsOut 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.
conclusionsIn 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.
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