A case study demonstrates the effectiveness of spinal cord neurostimulation in paraplegic patients with severe spinal cord injury. The research group coordinated by Silvestro Micera was involved in the project
The clinical case, published in Med – Cell Press and conducted by the multidisciplinary team of the MINELab, involving doctors, physiotherapists, and researchers from the IRCCS San Raffaele Hospital in Milan and the Vita-Salute San Raffaele University (UniSR) together with bioengineers from the Sant'Anna School of Advanced Studies in Pisa coordinated by Professor Silvestro Micera, describes the incredible recovery of a 33-year-old man with a traumatic spinal cord injury at the T11-T12 level extending to the spinal cord cone, which caused severe motor impairment due to damage to both the central and peripheral nervous systems. After surgically implanting a spinal cord neurostimulator in the epidural space, the researchers applied specific stimulation and rehabilitation protocols, significantly improving muscle strength, walking, and motor control.
This work is part of a research program that began with the first implantation of a spinal cord neurostimulator in 2023, performed by the team of neurosurgeons at the IRCCS San Raffaele Hospital, led by Professor Pietro Mortini, head of Neurosurgery at the IRCCS San Raffaele Hospital and full professor of Neurosurgery at the Vita-Salute San Raffaele University. The project continued with the publication in Science Translational Medicine in 2025 of the first results obtained on two implanted patients, demonstrating the effectiveness of the innovative epidural electrical stimulation protocol in the treatment of spinal cord injuries.
"With this case study, we have demonstrated, for the first time, the effectiveness of epidural electrical stimulation (EES) combined with rehabilitation in restoring lower limb motor function in a patient with paraplegia due to a severe injury extending to the conus medullaris, i.e., the terminal portion of the spinal cord, allowing him to stand upright and walk for short distances. “In addition to motor recovery, the stimulation led to a clinically significant improvement in neuropathic pain and overall quality of life for the patient,” explains Dr. Luigi Albano, neurosurgeon and researcher at the IRCCS San Raffaele Hospital and lead author of the study.
“The results of this study,” adds Professor Pietro Mortini, “offer new hope to patients with severe spinal cord injuries who have experienced a long period of immobility, offering the possibility of recovery that was unthinkable until recently thanks to the integration of advanced neuromodulation and personalized rehabilitation.”
Spinal cord injuries
The medullary cone is the terminal portion of the spinal cord, located approximately between the first and second lumbar vertebrae (L1–L2). In this area, the central nervous system merges functionally with the peripheral nervous system: an injury in this region can therefore compromise both the motor and sensory functions of the lower limbs and the autonomic control of vital functions such as urination, defecation, and sexuality. Spinal cord cone trauma can be caused by road accidents, falls, or violent events, and accounts for a significant proportion—over 50% of spinal injuries—involving the junction between the spinal cord and spinal roots.
“Due to the anatomical and functional complexity of this area, these injuries are among the most difficult to treat and often involve a combination of paraplegia, severe neuropathic pain, and sphincter disorders,” explains Dr. Luigi Albano. The clinical picture can vary from patient to patient, but in most cases, severe and persistent motor and sensory deficits are observed, which have a profound impact on quality of life and independence. Traditional treatment options are limited and focus mainly on rehabilitation, but the chances of recovery are generally modest. It is in this context that the application of epidural electrical stimulation represents a potential turning point, opening up new treatment prospects even for the most complex injuries."
The case study
The subject of this study is a 33-year-old man who suffered a severe spinal cord injury in the lower thoracic region (T11–T12) four years ago, resulting in paralysis of the lower limbs. The injury, classified as “incomplete” (grade C according to the ASIA scale), had severely compromised his ability to move.
Despite two intensive rehabilitation cycles following the accident, the patient was unable to walk or stand. Tests also revealed damage to the nerve roots connecting the spinal cord to the leg muscles (L4 to S1), indicating that the peripheral nervous system was also affected in addition to the central nervous system. This is a particularly difficult condition to treat, as traditional therapies rarely produce results when nerve circuits are damaged at multiple levels. To offer a new possibility, the patient was included in the clinical trial Neuro-SCS-001, which evaluates the effects of epidural electrical stimulation combined with a personalized rehabilitation program.
“We implanted a spinal cord stimulation system with 32 electrodes, positioning it between T11 and L1,” explains Professor Pietro Mortini. "Once activated, the stimulation allowed us to reactivate some residual nerve circuits, particularly those controlling the trunk muscles and hip flexors, which are essential for regaining posture and walking. After an initial calibration phase, the patient followed an innovative rehabilitation program that integrates exercises in a virtual reality environment, using sensory and motor feedback."
The results obtained thanks to the multidisciplinary approach
Thanks to the innovative rehabilitation program followed by the physiotherapists at the IRCCS San Raffaele Hospital, the improvements have been surprising: "In just three months, the patient showed a significant increase in hip range of motion, with a consequent improvement in lower limb mobility; he also improved his postural control of the trunk in a sitting position, allowing him to shift his center of gravity without losing balance. Finally, an increase in the angle of trunk flexion was observed, which was only noticeable with the active stimulator," comments Dr. Daniele Emedoli, a research physiotherapist at the Neurological-Cognitive-Motor Disorders Rehabilitation Unit at the IRCCS San Raffaele Hospital.
Over time, he gradually reduced the support needed to walk: from exercises on a treadmill with body weight support, he progressed to walking with the aid of a walker and braces. Upon discharge, he was already able to walk 58 meters in six minutes and complete the 10-meter test in just over 40 seconds. But the most incredible milestone came six months after the operation: he walked independently for one kilometer with only the aid of a walker and braces.
"The success of this journey demonstrates how essential teamwork is between physical therapists, physiatrists, neurologists, neurosurgeons, and engineers. – comments Dr. Sandro Iannaccone, Director of the Rehabilitation Department at the IRCCS San Raffaele Hospital – Only through close collaboration and a multidisciplinary approach, which integrates advanced neuromodulation techniques with technological and personalized rehabilitation, has it been possible to achieve such significant results in the patient's motor recovery."
Information for patients
People with spinal cord injuries who are interested in evaluating a diagnosis and treatment pathway with epidural electrical stimulation can contact the IRCCS San Raffaele Hospital. The multidisciplinary team of neurosurgeons, neurologists, and physical therapists evaluates each case individually, including in ongoing clinical studies. For more information, please write to the following email address: iocammino@hsr.it
