Max O Krucoff1,2, Robert Gramer3, Dana Lott4, Emily Kale4, Amol P Yadav5, Muhammad M Abd-El-Barr5, Saurabh R Sinha4, Shivanand P Lad5. 1. Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA. maxkrucoff@gmail.com. 2. Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA. maxkrucoff@gmail.com. 3. Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA. 4. Department of Neurology, Duke University Medical Center, Durham, NC, USA. 5. Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Abstract
INTRODUCTION: Epidural electrical stimulation of the conus medullaris has helped facilitate native motor recovery in individuals with complete cervicothoracic spinal cord injuries (SCI). A theorized mechanism of clinical improvement includes supporting central pattern generators intrinsic to the conus medullaris. Because spinal cord stimulators (SCS) are approved for the treatment of neuropathic pain, we were able to test this experimental therapy in a subject with complete L1 paraplegia and neuropathic genital pain due to a traumatic conus injury. CASE PRESENTATION: An otherwise healthy 48-year-old male with chronic complete L1 paraplegia with no zones of partial preservation (ZPP) and intractable neuropathic genital pain presented to our group seeking nonmedical pain relief and any possible help with functional restoration. After extensive evaluation, discussion, and consent, we proceeded with SCS implantation at the conus and an intensive outpatient physical therapy regimen consistent with the recent SCI rehabilitation literature. DISCUSSION: Intraoperatively, no electromyography (EMG) could be elicited with epidural conus stimulation. At 18 months after implantation, his motor ZPPs had advanced from L1 to L5 on the left and from L1 to L3 on the right. 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. Three validated functional and quality of life (QoL) surveys demonstrated substantial improvements. The modest motor response compared to the literature suggests likely critical differences in the anatomy of such a low injury. However, the change in ZPPs and QoL suggest potential for neuroplasticity even in this patient population.
INTRODUCTION: Epidural electrical stimulation of the conus medullaris has helped facilitate native motor recovery in individuals with complete cervicothoracic spinal cord injuries (SCI). A theorized mechanism of clinical improvement includes supporting central pattern generators intrinsic to the conus medullaris. Because spinal cord stimulators (SCS) are approved for the treatment of neuropathic pain, we were able to test this experimental therapy in a subject with complete L1 paraplegia and neuropathic genital pain due to a traumatic conus injury. CASE PRESENTATION: An otherwise healthy 48-year-old male with chronic complete L1 paraplegia with no zones of partial preservation (ZPP) and intractable neuropathic genital pain presented to our group seeking nonmedical pain relief and any possible help with functional restoration. After extensive evaluation, discussion, and consent, we proceeded with SCS implantation at the conus and an intensive outpatient physical therapy regimen consistent with the recent SCI rehabilitation literature. DISCUSSION: Intraoperatively, no electromyography (EMG) could be elicited with epidural conus stimulation. At 18 months after implantation, his motor ZPPs had advanced from L1 to L5 on the left and from L1 to L3 on the right. 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. Three validated functional and quality of life (QoL) surveys demonstrated substantial improvements. The modest motor response compared to the literature suggests likely critical differences in the anatomy of such a low injury. However, the change in ZPPs and QoL suggest potential for neuroplasticity even in this patient population.
Authors: Susan Harkema; Yury Gerasimenko; Jonathan Hodes; Joel Burdick; Claudia Angeli; Yangsheng Chen; Christie Ferreira; Andrea Willhite; Enrico Rejc; Robert G Grossman; V Reggie Edgerton Journal: Lancet Date: 2011-05-19 Impact factor: 79.321
Authors: Max O Krucoff; Jonathan P Miller; Tarun Saxena; Ravi Bellamkonda; Shervin Rahimpour; Stephen C Harward; Shivanand P Lad; Dennis A Turner Journal: Neurosurgery Date: 2019-01-01 Impact factor: 4.654
Authors: Yury P Gerasimenko; Daniel C Lu; Morteza Modaber; Sharon Zdunowski; Parag Gad; Dimitry G Sayenko; Erika Morikawa; Piia Haakana; Adam R Ferguson; Roland R Roy; V Reggie Edgerton Journal: J Neurotrauma Date: 2015-08-20 Impact factor: 5.269
Authors: A L Stewart; S Greenfield; R D Hays; K Wells; W H Rogers; S D Berry; E A McGlynn; J E Ware Journal: JAMA Date: 1989-08-18 Impact factor: 56.272
Authors: Timothy Y Wang; Christine Park; Hanci Zhang; Shervin Rahimpour; Kelly R Murphy; C Rory Goodwin; Isaac O Karikari; Khoi D Than; Christopher I Shaffrey; Norah Foster; Muhammad M Abd-El-Barr Journal: Front Surg Date: 2021-12-13