As published in the Hong Kong Medical Journal, a group of physicians provide a case report on a C1/C2 quadriplegic implanted with a breathing pacemaker 16 years post-injury.

"A 22-year-old healthy man sustained a traumatic fracture of the cervical spine at the level of C1/C2 when doing some exercises in the gymnasium in June 1991. He lost consciousness when he fell to the ground, and was brought to the hospital by ambulance. A computed axial tomographic scan of his cervical spine confirmed a high cervical spine injury. He remained in a tetraplegic state with chronic ventilatory failure. Rehabilitation was started but he remained ventilator-dependent, totally dependent in his daily activities of living, and had to stay in the orthopaedics ward. "

"Cardiothoracic surgeons implanted the breathing pacemaker system (Avery Biomedical Devices Inc., New York, US) into his phrenic nerves bilaterally, with a thoracoscope inserted in the 7th intercostal space at the anterior axillary line, and two anterior thoracotomies over the 3rd intercostal space on the left and the 2nd intercostal space on the right. One electrode was sutured to each phrenic nerve and the paired radioreceivers were implanted in subcutaneous pockets in the upper chest."

"Today, he can talk and be more interactive with his environment and the people around him. He leads an independent life when using the pacers for over 10 hours during the day. This has facilitated ambulation markedly, as he can use the breathing pacemaker while sitting in his automatic wheelchair, and participate in various activities outside the hospital. His exercise endurance and autonomic adaptations are much improved, in particular, his postural-related blood pressure changes."

"Implantation of the diaphragm pacers in appropriate subjects can lead to independent living, enhanced mobility, better quality of life, and ease their integration into society."

Lam J, Ho C, Poon TL, Kwok HW, Wong RK, Chiu SW, Ip M. "Implantation of a Breathing Pacemaker in a Tetraplegic Patient in Hong Kong" Hong Kong Med J 2009; Vol. 15, No. 3, pp. 230-233.