58-Year-Old Man Regains Ability to Breathe After Groundbreaking Surgery for Spinal Cord Injury
After six months on a ventilator due to a cervical spine fracture, a breakthrough phrenic nerve stimulation surgery helped restore independent breathing.
PUNE: Ruby Hall Clinic, a leader in pioneering medical treatments in Pune, has achieved a significant medical breakthrough with the successful performance of Maharashtra’s first Phrenic Nerve Neuromodulation surgery. This rare and complex procedure, led 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, has enabled a 58-year-old man, Mr. Sanjay Yashwant Pai, to breathe independently after being dependent on a mechanical ventilator for six months due to a spinal cord injury.
Mr. 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.
Recognizing the need for advanced care, Mr. Pai was transferred to Ruby Hall Clinic on September 19, 2024, for further management, including neuro-monitoring, ventilator weaning support, and rehabilitation. Upon arrival, 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 (Dr Richa Singh, Dr Manish Baldia, Dr Zirpe with his ICU team, and Dr Grant) at Ruby Hall Clinic chose to perform the Phrenic Nerve Neuromodulation surgery. 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.
Dr. Manish Baldia, Consultant Functional Neurosurgeon at Ruby Hall Clinic, who performed the surgery, said, “Despite all the extensive weaning efforts, we were unable to wean him, but soon after phrenic nerve stimulation surgery, we could notice a remarkable improvement in his breathing. This was a highly delicate and rare procedure in which we placed a small device near the phrenic nerve. With the help of this device, we were able to activate and control Mr. Pai’s diaphragm externally through a remote and initiate the process of ventilator weaning. We 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.”
Following the surgery, Mr. Pai showed excellent recovery. Gradually, his ventilator support was reduced, and by April 28, 2025, he was successfully shifted to the general ward for continued rehabilitation.
Dr. Purvez Grant, Chief Cardiologist, Managing Trustee, and Chairman of Ruby Hall Clinic, remarked, “At Ruby Hall Clinic, innovation and patient-centric care are at the heart of everything we do. Successfully performing Maharashtra’s first Phrenic Nerve Neuromodulation surgery showcases our commitment to pushing the boundaries of what is possible in medical care and giving our patients a second chance at life.” This remarkable achievement was made possible through the dedication and expertise of Ruby Hall Clinic’s ICU team (NTU2), setting a new standard for critical care and neurosurgical rehabilitation in Maharashtra
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