The LION Procedure to the Pelvic Nerves for Recovery of Locomotion in 18 Spinal Cord Injured Peoples – A Case Series
Marc Possover, MD, PhD, Director, Possover International Medical Center, Zurich, Switzerland, Professor, Neuropelveology, University of Aarhus, Aarhus, Denmark
We report on unexpected findings in 18 spinal cord injured peoples who underwent a laparoscopic bilateral implantation of neuroprosthesis (LION procedure) to the sciatic/femoral nerves pelvic somatic nerves for functional electrical stimulation (FES)-assisted locomotor training and continuous low-frequency electrical stimulation. Fifteen patients were paraplegics, three low tetraplegics, all of them fully dependent on a wheelchair. After a training period of at least one year, all patients not only started with electrical-assisted standing/stepping using a walker or crutches, but also developed some progressive caudalward recovery of lumbosacral sensoric functions and of supraspinal control of voluntary movements below the lesions. Twelve patients are currently capable of weight-bearing standing and stepping with crutches by simultaneous electrical stimulation (the best of the series for 2.6km), and six of them are capable of walking several meters (the best of the series for 400m) without electrical stimulation. Our findings suggest that FES-assisted locomotor training in combination with continuous low-frequency pelvic nerves in spinal cord injury patients may induce changes that affect the central pattern generator and allows supra- and infraspinal inputs to engage residual spinal or extra spinal pathways for reconnection.