Diaphragm Center Provides Specialized Treatment

The chief muscle of inspiration—the drawing in of breath—is the diaphragm, a thin sheet of muscle under the lungs. Most people do not have to think about the diaphragm, but when the diaphragm is paralyzed, breathing becomes labored and difficult. 

The primary cause of diaphragm paralysis is damage to the phrenic nerve, which originates in the neck and connects to the diaphragm muscles, says Mark Ginsburg, MD, associate professor of surgery. 

Dr. Ginsburg co-directs a new Diaphragm Center at Columbia with Keith Brenner, MD, assistant professor of medicine.

“If there’s damage to the phrenic nerve, the muscle doesn’t receive the signal generated by the brain to contract, and our ability to breathe can be impaired,” says Dr. Ginsburg. “Over time, the muscle thins out, and we essentially stop breathing with that side.” Lung capacity can be reduced by 50% in patients with paralysis on one side and by 70% to 80% in those with paralysis on both sides. 

Because the center sees more patients with diaphragm paralysis and dysfunction than most other hospitals in the world, its clinicians encounter patients with both common and rare forms of injury.

“The most frequent damage we see is a nerve injured during heart surgery,” Dr. Brenner says. The center first monitors such patients for a year or more to see if the nerve can regenerate. But if patients still have symptoms, a minimally invasive surgical procedure called plication can help by tightening the diaphragm and setting it in a lower position to improve inhalation.

“The majority of our patients benefit significantly,” says Dr. Ginsburg. “They come to us because they are short of breath. They can’t lie down, or sleep in a prone position, or bend down to tie their shoes without struggling. With a relatively simple surgery we can give these people back the breath of life.”

Less frequently, diaphragm paralysis is caused by a virus, tumors, autoimmune disorders, or neurological conditions. “These causes are not always easy to identify,” Dr. Brenner says. “One of the benefits of our center is that we see a high volume of patients and through experience, we know what the problems are. We have all the diagnostics and experienced colleagues throughout the medical center to consult with.”

The center also treats patients with other types of diaphragm dysfunction, including people with central sleep apnea and patients with traumatic injuries, ALS, diaphragm hernias, and multiple sclerosis who use respirators to breathe. In these cases, the insertion of a phrenic pacemaker can help patients breathe by signaling the diaphragm to contract.

“Many clinicians are not aware of the options available to treat these disorders,” says Dr. Ginsburg. “Through the center, we’ve been spreading the word, and we’re seeing many patients a week from around the globe.”


Contact the center at 212-305-3408 or read more at http://columbiasurgery.org/diaphragm.