Spinal cord stimulation and rehabilitation in an individual with chronic complete L1 paraplegia due to a conus medullaris injury: motor and functional outcomes at 18 months

This case report explores the use of spinal cord stimulation (SCS) combined with physical therapy to improve motor function and quality of life in a patient with complete paraplegia. The patient, who had a spinal cord injury at the L1 level resulting in complete paralysis and neuropathic pain, underwent SCS implantation at the conus medullaris and participated in an intensive physical therapy program. While the patient did not regain full motor function, improvements were observed in the zones of partial preservation, resting EMG amplitudes, and overall quality of life, suggesting potential for neuroplasticity even in this patient population.

• 1
  Motor ZPPs advanced from L1 to L5 on the left and from L1 to L3 on the right after 18 months of SCS and physical therapy.
• 2
  Qualitative increases in lower extremity resting state EMG amplitudes were noted, although there was no consistent evidence of voluntary EMG or rhythmic locomotive leg movements.
• 3
  Three validated functional and quality of life (QoL) surveys demonstrated substantial improvements after 18 months of motor rehabilitation with EES.