The trapezius muscles, dominated by spinal accessory nerves, can have an important role in reconstructing the respiratory function of patients with cervical SCI (Yang et al. 2011). The trapezius muscles (mainly innervated by the first and second levels of spinal cord, C1–2) have auxiliary inspiration function with the coordination of the muscles that attach the scapula to the rib cage (Yang et al. 2014). When extensive muscle paralysis is caused by cervical SCI, the scapula will slide up along the rib cage when the trapezius muscle contracts, limiting additional anatomical help with breathing (Yang et al. 2014). An innovative surgical technique using the trapezius muscles was developed and called “rib suspension surgery” (or thoracic breathing reconstruction); as the trapezius muscle strength is preserved in patients with injuries below C2 level, they can be surgically transferred to the rib cage through the scapula to recover the lost thoracic breathing, thus improving respiratory function (Yang et al. 2014).
A pre-post study by Yang et al. (2014) used rib suspension surgery; in which the trapezius muscle strength was surgically transferred to the rib cage through the scapula to recover the lost thoracic breathing. They found that people reported significantly increased VC post-surgery, improved breathing, cough, and expectoration 1-day post-surgery, and increased range of diaphragmatic activity 2-3 weeks post-surgery.
There is level 4 evidence (from one pre-post study: Yang et al. 2014) that used rib suspension surgery and found an improvement in breathing, cough and expectoration 1 day post-surgery, an increased range of diaphragmatic activity 2-3 weeks post-surgery, and a significantly increased VC post-surgery in patients with complete high cervical SCI.