A thirty -three man, made paraplegic by a incomplete medullary lesion at T11-T12 levelAnd Returned to walk Thanks to a neurostimulator implanted in epidural space and a highly personalized rehabilitation program. The case, published last May 28 in the specialized magazine Med – Cell Presswas born from the collaboration between the IRCCS San Raffaele Hospital in Milan, the Vita-Salute San Raffaele University and the Sant’Anna High School of Pisa. The results not only document a motor recovery deemed unthinkable so far but also show one significant reduction of neuropathic pain It is a clear improvement in the quality of life, opening new therapeutic perspectives for the most complex injuries of the medullary cone.
The clinical case
The patient, four years after the accident that had damaged the spinal cord and also involved the nerve roots from L4 to S1, was no longer able to stand or walk, despite two intensive physiotherapy cycles. It is a particularly difficult condition to treat, explains a note from the institutes, because traditional therapies rarely give results when the nerve circuits are damaged at several levels. Posted in the Neuro-Scons-001 trial, it was subjected to the plant of a System with thirty -two electrodes positioned between the T11 and L1 vertebrae. The intervention, performed by the San Raffaele neurosurghi team led by Pietro Mortiniconstitutes the evolution of a path started in 2023 with the First epidural stimulation system and already validated on two patients in a study published on Science Translational Medicine Always this year.
What is epidural electrical neurostimulation
There Epidural electrical stimulation (Ees) sends low intensity impulses that in essence rekindle residual spinal circuits, in particular those who control i trunk muscles and hip flexors, enhancing the transmission of motor signals. In the case described, the modulation has been adapted in real time to the patient’s clinical response and integrated with Exercises in virtual reality Able to enrich sensory feedback and encourage the plasticity of the nervous system.
The injuries of the medullary cone
The medullary cone, located Between the first and second lumbar vertebrais an area of ​​junction between central and peripheral nervous system. Damage here compromises not only the motor skills and sensitivity of the lower limbs, but also autonomous functions such as urination, defecation and sexual activity. The co -presence of central and peripheral injuries traditionally makes the recovery margins offered by conventional rehabilitation only modest. The trauma of the medullary cone can be caused by road accidents, falls or violent events, and represent a significant share – over 50% of spinal lesions – which involve the junction between marrow and spinal roots.
The rehabilitative path
After a phase of calibration of the stimulator, the patient followed a rehabilitation program that combined treadmill, robot-axis with weight drain, sessions in virtual reality and intensive training of the trunk balance. In three months the first signs of recovery appeared: greater hip excursion, better postural control from sitting and the possibility of moving the center of gravity without losing the balance. Discharged while traveling 58 meters in six minutes with walking and guardians, Six months later he reached a kilometer of autonomous journey with the same aids. «The results of this study offer new hopes for patients with serious medullary lesions who have lived a long period of immobility, offering the possibility of Untilian recoveries until recently Thanks to the integration of advanced neuromodulation and personalized rehabilitation, “explains Mortini.
Clinical results and prospects
In addition to the return to the upright and walking station, the protocol has as its said reduced in a clinically relevant way neuropathic pain and has improved the quality of life indexes. According to Mortini, these data offer new hopes for patients who have lived immobility for years, showing that the integration between advanced neuromodulation and personalized rehabilitation can translate into recoveries considered unreachable so far. «With this case study we have demonstrated, for the first time, the effectiveness of epidural electrical stimulation (Epidural Electrical Stimulation, EES) assisted by rehabilitation in restoring the motor functions of the lower limbs in a patient suffering from paraplegia due to one severe injury extended to the medullary cone, or the terminal portion of the spinal cordallowing him to reach the erect and walking station for short distances, “he added Luigi Albanoneurosurgeon and researcher of the IRCCS San Raffaele Hospital and first author of the study. «In addition to motor recovery, stimulation has led to a Clinically relevant improvement of neuropathic pain And of the quality of life overall of the patient ».
The next steps will include multicenter studies on larger cases and the optimization of stimulation algorithms, with the aim of making the Ees integral of the standard of care for incomplete paraplegia and the lesions of the medullary cone.
«The success of this path demonstrates how fundamental the teamwork Between physiotherapists, physiatrists, neurologists, neurosurgery and engineers », he concludes Sandro Iannacconedirector of the Rehabilitation Department of the IRCCS San Raffaele Hospital. Only thanks to one close collaboration and a multidisciplinary approachwhich integrates advanced neuromodulation techniques with technological and personalized rehabilitationit was possible to achieve such significant results in the patient recovery of the patient ».
Scientific sources mentioned in this article:
Spinal cord injury: identified a group of neurons that restore walking after paralysis
Source: Vanity Fair
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