10-years experience with continuous low-frequency pelvic somatic nerves stimulation for recovery of voluntary walking in chronic spinal cord injured peoples: a prospective case series of 29 consecutive patients.

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 neuroprothesis (LION procedure) in the pelvic lumbosacral nerves. Design Observational case report Setting Tertiary referral unit specialized in advanced gynecological surgery and neuropelveology. Participants Twenty-nine patients 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 pre-selected patients but includes patients across the entire range of spinal cord injuries: paraplegics, tetraplegics (except for high tetraplegics) as well as patients with complete and incomplete spinal cord injuries and even patients with flaccid or spastic paralysis. Intervention Patients underwent in-body FES-assisted locomotor training and continuous low-frequency pelvic lumbosacral nerve neuromodulation. Main Outcome Measures Evolution of 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 nine years, twenty 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 meters (67.8%), height of them only at the bar (28.5%), and eleven of them with the aid of crutches/walker and without braces (40%). Conclusions The major finding of our study is that seventeen out of a total of twenty-five complete motor chronic SCI-patients (68%) developed enough recovery of supra-spinal control of leg movements, that voluntary walking became feasible, even though a minimal amount of stimulation may be required.