Breakthrough at San Raffaele: neurostimulation restores movement after severe spinal cord injury

A clinical case, published in Med – Cell Press and conducted by the multidisciplinary team of the MINE Lab, involving physicians, physiotherapists, and researchers from IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University (UniSR), in collaboration with bioengineers from the Sant’Anna School of Advanced Studies in Pisa led by Professor Silvestro Micera, describes the extraordinary recovery of a 33-year-old man with a traumatic spinal cord injury at the T11–T12 level, extending to the conus medullaris. This caused severe motor deficits due to damage involving both the central and peripheral nervous systems.

Following the surgical implantation of an epidural spinal cord neurostimulator, the researchers applied specific stimulation and rehabilitation protocols, resulting in significant improvements in muscle strength, gait, and motor control.

This work continues a research pathway that began with the first implantation of a spinal neurostimulator in 2023, performed by the neurosurgical team at IRCCS Ospedale San Raffaele, led by Professor Pietro Mortini, Chief of Neurosurgery Department and Full Professor of Neurosurgery at Vita-Salute San Raffaele University.

The project continued with the 2025 publication in Science Translational Medicine of initial results in two patients, confirming the effectiveness of the innovative epidural electrical stimulation (EES) protocol for spinal cord injury treatment.

“With this case study, we have demonstrated for the first time the effectiveness of epidural electrical stimulation (EES) combined with rehabilitation in restoring lower limb motor function in a paraplegic patient with a severe lesion involving the conus medullaris, the terminal portion of the spinal cord. Thanks to the intervention, the patient was able to stand upright and walk short distances,” explains Dr. Luigi Albano, neurosurgeon and researcher at IRCCS Ospedale San Raffaele and first author of the study.

“In addition to motor recovery, the stimulation also led to a clinically significant reduction in neuropathic pain and an improvement in overall quality of life. The results of this study, offer new hope to patients with severe spinal cord injuries who have experienced prolonged immobility. The combination of advanced neuromodulation and personalized rehabilitation now makes possible what was until recently unthinkable,” adds Professor Mortini.

The conus medullaris is the terminal portion of the spinal cord, located roughly between the first and second lumbar vertebrae (L1–L2). In this region, the central and peripheral nervous systems functionally merge. Therefore, injury in this area can impair not only motor and sensory function of the lower limbs, but also autonomic control of essential functions such as urination, defecation, and sexual activity.

Traumatic injuries to the conus medullaris can result from traffic accidents, falls, or violent events, and account for over 50% of spinal cord injuries involving the junction between the spinal cord and spinal nerve roots.

“Due to the anatomical and functional complexity of this area, these injuries are among the most challenging to treat, often resulting in a combination of paraplegia, severe neuropathic pain, and sphincter dysfunctions. The clinical presentation varies from patient to patient, but severe and persistent motor and sensory deficits are common and significantly impact quality of life and independence. Traditional treatment options are limited and focus primarily on rehabilitation, with generally modest recovery potential. This is why epidural electrical stimulation could be a breakthrough in treating even the most complex spinal cord injuries,” explains Dr. Albano.

The subject of this study is a 33-year-old man who, four years earlier, had suffered a severe lower thoracic spinal cord injury (T11–T12) resulting in paralysis of the lower limbs. The injury was classified as incomplete (ASIA grade C), yet significantly impaired his mobility.

Despite undergoing two intensive rehabilitation programs after the accident, the patient was unable to stand or walk. Diagnostic tests also revealed damage to the nerve roots connecting the spinal cord to leg muscles (from L4 to S1), indicating that both central and peripheral nervous systems were affected, a particularly complex clinical scenario, as traditional treatments rarely yield results when neural circuits are impaired at multiple levels.

To provide a new therapeutic opportunity, the patient was enrolled in the Neuro-SCS-001 clinical trial, which evaluates the effects of epidural electrical stimulation combined with a personalized rehabilitation program.

“We implanted a spinal cord stimulation system with 32 electrodes, positioning it between T11 and L1. Once activated, the stimulation reactivated residual neural circuits, particularly those controlling trunk muscles and hip flexors, which are essential for restoring posture and gait. After an initial calibration phase, the patient followed an innovative rehabilitation program, incorporating virtual reality environments with sensory and motor feedback,” explains Professor Mortini.

"Thanks to the innovative rehabilitation program, supervised by physiotherapists at IRCCS Ospedale San Raffaele, the patient experienced remarkable progress:

• Within just 3 months, he showed a significant increase in hip range of motion, leading to enhanced lower limb mobility.
• He improved trunk control while sitting, allowing shifting of his center of gravity without losing balance.
• He also demonstrated greater trunk flexion, observable only with the stimulator active," notes Dr. Daniele Emedoli, physiotherapist and researcher in the Neurological-Cognitive-Motor Disorders Rehabilitation Unit at San Raffaele.

Over time, the patient gradually reduced his dependency on walking aids: from treadmill exercises with body weight support, he progressed to walking with the help of a walker and leg braces.

Upon discharge, he could walk 58 meters in 6 minutes and complete the 10-meter walk test in just over 40 seconds. But the most impressive milestone came 6 months post-implantation: he was able to walk 1 kilometer independentlywith only the walker and braces.

“The success of this rehabilitation pathway proves how essential it is to have teamwork between physiotherapists, physiatrists, neurologists, neurosurgeons, and engineers. Only through close interdisciplinary collaboration and the integration of advanced neuromodulationwith personalized technological rehabilitation was it possible to achieve such significant motor recovery,” comments Dr. Sandro Iannaccone, Director of the Rehabilitation Department at IRCCS Ospedale San Raffaele.