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

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 stimulationeassisted 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. Archives of Physical Medicine and Rehabilitation 2021;102:50-7 (c) 2020 by the American Congress of Rehabilitation Medicine

Automated summary

The study reported the long-term effects of low-frequency stimulation of pelvic somatic nerves in patients with chronic spinal cord injuries, showing that most patients experienced some degree of recovery after stimulation training. Many patients were able to stand and walk to some extent after long-term follow-up.