Assistant Professor Houston Methodist Neurological Institute Houston, Texas, United States
Disclosure(s):
Sean Barber, MD: No financial relationships to disclose
Introduction: Spinal cord injury (SCI) leads to devastating deficits in motor, sensory and autonomic function that often substantially impact patient quality of life and impart considerable socioeconomic burden. To date, no interventions have led to a meaningful impact on recovery of motor function after SCI. Animal studies have demonstrated that motor recovery may be augmented by spinal cord stimulation (SCS). SCS is traditionally performed via implantation of a dorsal stimulator. Being that the motor neurons lie in the ventral portion of the spinal cord, however, stimulation via a ventral electrode would theoretically allow for lower-amplitude stimulation with higher specificity for motor unit recruitment. Animal studies have shown that ventral stimulation is achievable, but this has not yet been performed in humans.
Methods: We describe the case of a patient presenting with spinal cord injury who underwent thoracic corpectomy along with placement of two ventral spinal cord stimulator electrodes as part of an FDA-approved and IRB-approved clinical trial.
Results: Mild lead migration was seen on post-operative day #1. Stimulation was performed during 1-hour physical therapy sessions 3 times weekly. The patient tolerated stimulation well at an amplitude of 0.5 – 3.5 mA and frequency of 30 Hz without untoward effects. Quantifiable improvements in flexor muscle function in the legs were seen during stimulation-ON muscle testing when compared with stimulation-OFF muscle testing.
Conclusion : Ventral SCS has potential physiologic advantages for treatment of patients with SCI. Although further study is needed to establish therapeutic efficacy, the present report provides critical proof of principle for the feasibility and safety of the transpedicular corpectomy approach to implement ventral SCS for SCI.
