Cervical medullary injury often leads to diaphragmatic paralysis, and patients experience respiratory distress, often requiring tracheotomy and ventilator-assisted ventilation. After acute treatment, due to severe respiratory dysfunction, some patients require long-term ventilator maintenance or can only be taken off the ventilator intermittently on a daily basis; some patients, although barely off the ventilator, are in a state of chronic hypoxia, and patients often experience respiratory distress during increased activity, fever, or at night. For patients with high cervical medullary injury with well-preserved paramedian nerve function, the paramedian nerve can be used to replace the paralyzed phrenic nerve to restore the function of the paralyzed diaphragm, and the patient can be trained to perform synchronous activities of shoulder shrugging and inspiration to rebuild spontaneous and coordinated abdominal breathing. The clinical application of this idea was reported by Yang et al. of the Chinese Rehabilitation Research Center. A 44-year-old, male, patient with C2 complete spinal cord injury underwent surgery 11 months after the injury. The patient had a severe spinal cord injury at the C2 level caused by a fall while riding a bicycle. except for the paraspinal innervated trapezius muscle, which was well preserved (able to perform a shoulder shrug), the strength of the deltoid and the following muscles was 0. X-ray fluoroscopy showed complete paralysis of the right diaphragm and only slight movement of the left diaphragm. The patient was barely off the ventilator at 10 months post-injury, but had frequent dyspnea in fever, changing positions, and at night, requiring oxygen or intermittent assisted ventilation for relief. Within the posterior cervical triangle, the rhomboid branch of the patient’s right paramedian nerve was transferred for end-lateral anastomosis with the ipsilateral phrenic nerve, and postoperative training was given to synchronize shrugging and inspiratory activity. Six months after surgery, the patient showed contraction of the right diaphragm and restored partial function, while improvement in pulmonary function and coughing ability was observed. The use of the paramedian nerve to replace the paralyzed phrenic nerve to restore the function of the paralyzed diaphragm provides a new treatment option for the reconstruction of respiratory function in patients with high-grade cervical medullary injury.