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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 13, 2020
Footnotes
Disclosures: Dr Possover has a patent issued to No. US,8,019,423 (February 2007).
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
