Pune: In a landmark advancement for critical care and neurosurgery, Ruby Hall Clinic, Pune, has successfully performed Maharashtra’s first Phrenic Nerve Neuromodulation surgery—offering new hope to patients reliant on long-term mechanical ventilation due to spinal cord injuries.
The complex and rare procedure was led by Dr. Kapil Zirpe, Head of the Neuro Trauma Unit and Senior Intensivist, alongside Dr. Manish Baldia, Consultant Functional Neurosurgeon, who carried out the surgery. Their combined expertise enabled 58-year-old Sanjay Yashwant Pai to breathe independently after spending over six months on a ventilator following a severe cervical spine injury.
Mr. Pai sustained a high cervical spine trauma (C3-C4 level) on July 25, 2024, after slipping in his bathroom. Initially treated at another facility, he underwent several spinal procedures, including a C4 corpectomy and spinal fusion surgeries. Despite surgical intervention, he remained quadriplegic and dependent on ventilator support due to significant spinal cord compression observed on imaging, though no brain abnormalities were detected.
Recognizing the complexity of his condition and the growing risks of prolonged ventilator use—including pneumonia, stress ulcers, blood clots, and pulmonary complications—Mr. Pai was transferred to Ruby Hall Clinic on September 19, 2024, for advanced ICU care, ventilator weaning, and neuro-rehabilitation. At admission, he was alert but dependent on mechanical ventilation and PEG feeding, while receiving antibiotics.
Given the critical nature of his condition, the multi-disciplinary team—comprising Dr. Richa Singh, Dr. Manish Baldia, Dr. Kapil Zirpe, Dr. Purvez Grant, and the Neuro Trauma ICU (NTU2) staff—opted for an advanced intervention: Phrenic Nerve Neuromodulation. This cutting-edge technique involves stimulating the diaphragm, the primary muscle used for breathing, by placing a small device near the phrenic nerve.
“This was a highly intricate and rarely performed procedure,” explained Dr. Baldia. “Despite exhaustive weaning trials, the patient could not breathe independently. Once the phrenic nerve stimulator was implanted, we observed a significant improvement. The device allowed us to externally activate the diaphragm using a remote system. By carefully adjusting the stimulator to match his physiological responses, we gradually built his diaphragm strength without causing fatigue.”
Following the surgery, Mr. Pai showed progressive improvement. His dependence on mechanical ventilation steadily decreased, and by April 28, 2025, he was shifted out of the ICU to a general ward for continued rehabilitation.
Commenting on this medical milestone, Dr. Purvez Grant, Chief Cardiologist and Chairman of Ruby Hall Clinic, said, “This achievement underlines Ruby Hall’s commitment to pioneering treatments and placing patient outcomes at the core of our mission. Performing Maharashtra’s first successful Phrenic Nerve Neuromodulation surgery reflects our dedication to innovation in healthcare and our resolve to improve lives.”
This groundbreaking procedure sets a new benchmark for neurocritical care in the state, demonstrating the impact of collaborative, patient-centered medical innovation.
