{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T13:22:05Z","timestamp":1783344125066,"version":"3.54.6"},"reference-count":14,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Synapse Biomedical"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background\/Objectives: Cervical 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. Methods: We 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\u201384.0 months; range: 12.0\u2013120.0 months). Results: Out of 30 initial candidates with cervical SCI, 28 patients (22 males, 6 females; median age 24.0 years (interquartile range [IQR]: 15.0\u201333.0 years)) were included. Patients had been on MV for a median of 13.0 months (IQR: 10.5\u201316.0 months) prior to the procedure. Utilizing a combined weaning success rate (complete or partial weaning), 26 patients (92.86%; 95% CI: 77.42\u201398.01%) 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 (\u22654 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. Conclusions: In 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.<\/jats:p>","DOI":"10.3390\/medsci14030375","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T12:01:37Z","timestamp":1783339297000},"page":"375","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Laparoscopic Diaphragmatic Pacing in Spinal Cord Injury Patients with Respiratory Failure: A Saudi Arabian Experience"],"prefix":"10.3390","volume":"14","author":[{"given":"Suha","family":"Kaaki","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Thoracic Surgery, King Saud University, Riyadh 11472, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aya K.","family":"Aldayel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh 14214, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7916-972X","authenticated-orcid":false,"given":"Waseem M.","family":"Hajjar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Thoracic Surgery, King Saud University, Riyadh 11472, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0024-3751","authenticated-orcid":false,"given":"Ahmad W.","family":"Hajjar","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2882-8364","authenticated-orcid":false,"given":"Sami A.","family":"Al-Nassar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Thoracic Surgery, King Saud University, Riyadh 11472, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"key":"ref_1","first-page":"64","article-title":"Respiratory Care of Patients with Cervical Spinal Cord Injury: A Review","volume":"14","author":"Arora","year":"2012","journal-title":"Crit. 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Trauma Acute Care Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"303\u2013309; discussion 309\u2013310","DOI":"10.1097\/TA.0000000000000112","article-title":"Multicenter Review of Diaphragm Pacing in Spinal Cord Injury: Successful Not Only in Weaning from Ventilators but Also in Bridging to Independent Respiration","volume":"76","author":"Posluszny","year":"2014","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"7973","DOI":"10.4081\/pr.2019.7973","article-title":"Pediatric Diaphragmatic Pacing","volume":"11","author":"Hazwani","year":"2019","journal-title":"Pediatr. Rep."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/3\/375\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T13:10:19Z","timestamp":1783343419000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/3\/375"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,4]]},"references-count":14,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["medsci14030375"],"URL":"https:\/\/doi.org\/10.3390\/medsci14030375","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,4]]}}}