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Ten-Year Experience With Continuous Low-Frequency Pelvic Somatic Nerves Stimulation for Recovery of Voluntary Walking in People With Chronic Spinal Cord Injury: A Prospective Case Series of 29 Consecutive Patients

Published:October 13, 2020DOI:https://doi.org/10.1016/j.apmr.2020.09.382

      Abstract

      Objective

      The purpose of this study was to report on long-term effects of low-frequency stimulation of the pelvic somatic nerves in patients with chronic spinal cord injuries who underwent laparoscopic implantation of neuroprosthesis (LION) in the pelvic lumbosacral nerves.

      Design

      Observational case report.

      Setting

      Tertiary referral unit specialized in advanced gynecologic surgery and neuropelveology.

      Participants

      Patients (N=29) with chronic SCI who underwent a LION procedure to the pelvic lower motor neurons for the recovery of standing and walking motion. Our study is not composed of preselected patients but includes patients across the entire range of SCIs: patients with paraplegia, patients with tetraplegia (except for high tetraplegia), patients with complete and incomplete SCIs, and even patients with flaccid or spastic paralysis.

      Intervention

      Patients underwent in-body functional electrical stimulation–assisted locomotor training and continuous low-frequency pelvic lumbosacral nerve neuromodulation.

      Main Outcome Measures

      Evolution of American Spinal Injury Association (ASIA) sensory score, ASIA Lower Extremity Motor Score, and Walking Index.

      Results

      All patients with incomplete SCI regained some voluntary control of previously paralyzed muscles after a few months of stimulation training. With a follow-up of 9 years, 20 patients (71.4%) were able to demonstrate an electrically assisted voluntary extension of the knee. Twenty-six patients could get to their feet when the pacemaker was switched on (92.8%). Five patients could walk <10 m (17.85%) at the bar. Nineteen patients (Abbreviated Injury Score [AIS] A: n=8; AIS B: n=9; AIS C: n=2) could walk >10 m (67.8%), 8 of them only at the bar (28.5%) and 11 of them with the aid of crutches or a walker and without braces (40%).

      Conclusions

      The major finding of our study is that 17 of 25 patients with complete motor chronic SCI (68%) developed enough recovery of supraspinal control of leg movements that voluntary walking became feasible, even though a minimal amount of stimulation may be required.

      Keywords

      List of abbreviations:

      AIS (Abbreviated Injury Score), ASIA (American Spinal Injury Association), FES (functional electrical stimulation), LION (laparoscopic implantation of neuroprosthesis), SCI (spinal cord injury), WISCI (Walking Index for Spinal Cord Injury)
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