Spinal cord stimulation has been used for 50 years to treat chronic intractable pain. Through an electrode introduced into the spinal canal connected to a generator of electrical impulses, the posterior spinal roots are stimulated, which leads to a reduction in the perception of pain.
Gradually, this method also began to be used in patients after a spinal cord injury.
At least it allows me to rehabilitate parts of my body that I can’t feel and move, which is great in the long run if I want to maintain muscle function.
E.g. scientists in the USA have discovered that if an electrode is placed in the area where the nerves connected to the muscles of the lower limbs depart from the spinal cord, these muscles can be activated with the help of stimulation and thus cause movement of the limb.
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Stimulation takes place below the level of the original spinal cord lesion – in an area that is not functionally damaged, but no signals from higher centers can enter it.
- In the last 20 years, works have been published that describe the use of epidural spinal cord stimulation to restore standing and walking for shorter distances – even in patients who had a complete loss of lower limb movement after a spinal cord injury. Some of them even regained active – i.e. will-controlled – movement of their limbs after several months of stimulation.
At the workplace of the Spinal Unit at the Clinic of Rehabilitation and Physical Education Medicine of the 2nd Faculty of Medicine of Charles University (2nd Faculty of Medicine UK) and FN Motol, the doctors, after several months of preparation, started painful conditions project epidural spinal cord stimulation.
Saving was not easy
“For the first spinal cord stimulation, we indicated a 32-year-old patient with a complete spinal cord lesion after a fracture of the 4th and 5th thoracic vertebra, which he caused when he fell on a bicycle three years ago,” described the head of the Spinal Unit at the Clinic of Rehabilitation and Physical Education Medicine of the 2nd Faculty of Medicine, UK and FN Motol Jiří Kříž.
“We inserted the electrode under X-ray control, its placement was relatively complex, as it must be accurate not only in terms of height, but also in terms of lateral deviations,” explained operator Ondřej Bradáč, head of the Department of Neurosurgery for Children and Adults at the 2nd Faculty of Medicine of the University of Warsaw and the Motol University Hospital .
On the third day after neurostimulator implantation, stimulation of various muscle groups of the lower limbs was started in relaxed positions on the back and on the side. The doctors gradually adjusted the patient’s stimulation parameters for movement against gravity and active muscle support while standing.
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According to Kříž, long-term rehabilitation will now take place with the aim of stimulating even more complex muscle interactions and using stimulation for active standing. “Ideally, even for shorter walks with aids,” added the headmaster.
And what about the patient himself? “When the system is turned on, I perceive that some movement is taking place, even if only to a minimal extent for now. We will see in time whether the response will improve,” said the first operated patient, Mr. Mikuláš.
“At least it allows me to rehabilitate parts of my body that I can’t feel and move, which is great in the long run if I want to keep my muscles functional,” he concluded.