High cervical medullary injury (C1-4) is a fatal trauma that, in addition to causing severe quadriplegia, often involves the respiratory center in the spinal cord (phrenic nucleus, C3-5), resulting in respiratory arrest or severe respiratory dysfunction. Respiratory dysfunction after high cervical medullary injury is manifested by severe pulmonary hypoventilation due to paralysis of the diaphragm and severe paradoxical respiration due to paralysis of the auxiliary inspiratory muscles attached to the chest wall, further weakening the residual diaphragm function. The clinical manifestations of patients are characterized by dyspnea, cough, weakness of sputum expulsion, weakness of articulation, retention of secretions in the pulmonary airways, high pulmonary complications, and high mortality. In the treatment of patients with high cervical medullary injury, respiratory management is the most problematic issue. A new surgical technique, thoracic respiratory function reconstruction, was reported by Yang et al. from the Chinese Rehabilitation Research Center. This study concluded that in patients who survive a high cervical medullary injury, the level of nerve damage is mostly C2-4, and these patients have well preserved collateral nerve function. The paraspinal nerve innervates the trapezius muscle, which ends at the scapular post and can lift the scapula, and has an auxiliary inspiratory effect through the muscles attached to the scapula and ribs (e.g., the anterior serratus). However, in patients with cervical marrow injury, because most of the muscles attached to the scapula are paralyzed, when the upper trapezius muscle bundle contracts, the scapula slides upward along the thorax, and its auxiliary inspiratory effect, basically, is abolished. Therefore, the subscapularis angle can be used to suspend the ribs, transfer the muscle force of the trapezius muscle to the thorax, and rebuild the thoracic respiratory power in patients with high cervical medullary injury. The authors reported 6 cases of clinical application. This group of patients had severe preoperative pulmonary hypoventilation, and the lung function improved more significantly after surgery, with an increase in spirometry from preoperative (1082±92) mL to (1680±282) mL 2 weeks after surgery, along with a significant improvement in the patient’s cough, sputum and articulation. The authors suggest that this technique may improve respiratory function in 3 ways: 1. The rhomboid muscle is a powerful auxiliary inspiratory muscle that establishes a synchronous activity pattern with the diaphragm and can provide thoracic respiratory power; 2. Suspension of the thoracic ribs exerts a traction force on the inferior chest wall to counteract inspiration, when the negative thoracic pressure causes soft tissue invagination of the chest wall; 3. Increasing the circumference of the diaphragm attachment to the chest wall area, strengthening the diaphragm initiation point support, and improving the diaphragm muscle work efficiency. Since this is a new technique, the authors believe that its clinical effectiveness and indications for surgery require further study. At present, it is mainly recommended for patients with high cervical medullary injuries in the C2-4 range who also have partial diaphragmatic dysfunction, respiratory distress, and need artificially assisted ventilation (or oxygen support).