Bilateral Diaphragmatic Nerve Paralysis Secondary to Cervical Spondylosis: A Rare Case

Bilateral diaphragmatic nerve paralysis due to cervical spondylosis is an extremely rare condition with only one previously reported case. We present a 64-year-old Japanese male with a history of left diaphragmatic nerve paralysis who developed sudden nocturnal dyspnea. Physical examination revealed orthopnea and type 2 respiratory failure. Imaging studies showed bilateral diaphragmatic elevations and cervical spine stenosis at C3/C4 and C4/C5 levels. Pulmonary function tests demonstrated a significant reduction in vital capacity, particularly in the supine position. After excluding other potential causes, the diagnosis of bilateral diaphragmatic nerve paralysis secondary to cervical spondylosis was established. The patient was successfully treated with noninvasive positive pressure ventilation (NPPV) and showed gradual improvement in symptoms and diaphragmatic function over three years of follow-up. This case highlights the importance of considering cervical spondylosis as a potential etiology for bilateral diaphragmatic nerve paralysis and demonstrates the effectiveness of NPPV in managing this rare condition. Regular monitoring and long-term follow-up are crucial for optimal management of these patients.