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Case Reports
. 2025 Oct 10;6(10):100706.
doi: 10.1016/j.medj.2025.100706. Epub 2025 May 27.

Epidural electrical stimulation facilitates motor recovery in spinal cord injury involving the conus medullaris: A case study

Luigi Albano  1 , Daniele Emedoli  2 , Filippo Agnesi  3 , Simone Romeni  4 , Elena Losanno  3 , Laura Toni  3 , Veronica Fossati  3 , Chiara Ciucci  3 , Filippo Gasperotti  2 , Leonardo Cociani  2 , Giovanni Zucco  2 , Edoardo Pompeo  5 , Cinzia Mura  5 , Jacopo Carpaneto  6 , Andrea Tettamanti  2 , Veronica Castelnovo  7 , Jeffrey David Padul  2 , Carlo Mandelli  5 , Lina Raffaella Barzaghi  5 , Federica Alemanno  2 , Heike Caravati  8 , Carla Butera  8 , Ubaldo Del Carro  8 , Antonella Castellano  9 , Andrea Falini  9 , Federica Agosta  10 , Massimo Filippi  11 , Sandro Iannaccone  2 , Pietro Mortini  12 , Silvestro Micera  13
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Free article
Case Reports

Epidural electrical stimulation facilitates motor recovery in spinal cord injury involving the conus medullaris: A case study

Luigi Albano et al. Med. .
Free article

Abstract

Background: Emerging research increasingly supports that epidural spinal cord electrical stimulation (EES) combined with neurorehabilitation can improve motor recovery in spinal cord injury (SCI) subjects. Patients with lesions involving the medullary cone may be challenging to treat with this approach, probably due to potential peripheral nervous system damage, leaving the open question of whether this large population may benefit from EES.

Methods: A T11-T12 SCI patient, with medullary cone involvement, underwent EES implant in a clinical trial (NCT05926843). During three months of testing, we determined optimal stimulation protocols for improving isolated movements and integrated them to reinstate independent walking with a walker.

Findings: EES substantially boosted hip flexor, spinal erector, and abdominal muscle contraction, improving the patient's performance in isolated movements. Over three months of combining continuous subthreshold EES with personalized rehabilitation, the patient progressed from being unable to walk to overground ambulation using a two-wheeled walker and bilateral knee and foot orthoses. At the time of hospital discharge, the patient managed to cover 58 m in the 6-min walking test and completed the 10-meter walking test in 40.29 s. Six months after EES implant, the patient was able to walk independently for 1 km with a walker.

Conclusions: These results underscore the potential of neurorehabilitation protocols integrating EES also for patients with medullary cone lesions and pave the way for new rehabilitation prospects.

Funding: This work was funded by Università Vita-Salute San Raffaele, Boston Scientific Spa, Fondazione Cariplo, Bertarelli Foundation, and the Ministry of University and Research (MUR).

Keywords: Translation to patients; conus medullaris; epidural electrical stimulation; neuromodulation; spinal cord injury; spinal cord stimulation; trauma.

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Conflict of interest statement

Declaration of interests L.A. receives or has received research support from Boston Scientific and Fondazione Cariplo. S.M. holds patents on spinal cord stimulation technologies. P.M. receives or has received research support from Boston Scientific. M.F. is editor-in-chief of the Journal of Neurology, associate editor of Human Brain Mapping, Neurological Sciences, and Radiology; has received compensation for consulting services from Alexion, Almirall, Biogen, Merck, Novartis, Roche, and Sanofi and for speaking activities from Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili SpA, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA; has participated in advisory boards for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, and Takeda; has participated in scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, and Sanofi-Genzyme; and receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla. F.A. is associate editor of NeuroImage: Clinical; has received speaker’s honoraria from Biogen Idec, Italfarmaco, Roche, Zambon, and Eli Lilly; and receives or has received research support from the Italian Ministry of Health, the Italian Ministry of University and Research, AriSLA (Fondazione Italiana di Ricerca per la SLA), the ERC, the EU Joint Programme—Neurodegenerative Disease Research (JPND), and Foundation Research on Alzheimer Disease (France).

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