Diaphragm pacing (DP) is a useful and cost-effective alternative to mechanical ventilation in patients with ventilator-dependent spinal cord injury and central hypoventilation syndrome. Patients with SCI should be carefully screened to assess the integrity of their phrenic nerves. In eligible patients, DP improves mobility, speech, olfaction, and quality of life. The stigma of being attached to a mechanical device and risk of ventilator disconnection are eliminated. There is also some evidence that DP results in a reduction in the rate of respiratory tract infections. DP is associated with infrequent side effects and complications, such as wire breakage, radiofrequency failure, and infection.