San Raffaele Hospital: World's First Case Study Demonstrates the Effectiveness of Spinal Cord Neurostimulation in a Paraplegic Patient with Severe Conus Medullaris Injury

The study, published in Med by Cell Press and authored by physicians and researchers from the MINE Lab, documents the recovery of walking ability through epidural electrical stimulation in a paraplegic patient with a spinal cord injury at the T11–T12 level. These types of injuries account for over 50% of all spinal cord lesions.

MILAN, June 17, 2025 /PRNewswire/ -- A clinical case published in Med – Cell Press by the multidisciplinary team of the MINE Lab – including doctors, physiotherapists, and researchers from San Raffaele Hospital and Vita-Salute San Raffaele University, in collaboration with bioengineers from Scuola Superiore Sant'Anna in Pisa led by Professor Silvestro Micera – describes the remarkable recovery of a 33-year-old man with a traumatic spinal cord injury at the T11–T12 level that extended into the conus medullaris. The injury caused severe motor impairment due to damage to both the central and peripheral nervous systems. After surgically implanting an epidural spinal cord neurostimulator, the team applied specific stimulation and rehabilitation protocols, significantly improving the patient's muscle strength, mobility, and motor control.

This research builds on a path that began with the first implantation of a spinal cord neurostimulator in 2023, carried out by the neurosurgical team at IRCCS Ospedale San Raffaele led by Professor Pietro Mortini, Head of Neurosurgery at the hospital and Full Professor of Neurosurgery at Vita-Salute San Raffaele University. The path continued with the publication, in Science Translational Medicine in 2025, of the first results from two implanted patients, demonstrating the effectiveness of the innovative epidural electrical stimulation (EES) protocol for treating spinal cord injuries.

"With this case study, we have shown for the first time the effectiveness of epidural electrical stimulation (EES) combined with rehabilitation in restoring lower limb motor functions in a paraplegic patient with a severe conus medullaris injury—the terminal portion of the spinal cord—enabling him to stand and walk short distances," explained Dr. Luigi Albano, neurosurgeon and researcher at San Raffaele Hospital and first author of the study. "Beyond motor recovery, the stimulation also led to clinically significant improvements in neuropathic pain and the patient's overall quality of life."

"The results of this study," added Professor Pietro Mortini, "offer new hope to patients with severe spinal cord injuries who have experienced long periods of immobility, making previously unimaginable recovery possible through the integration of advanced neuromodulation and personalized rehabilitation."

About Conus Medullaris Injuries

The conus medullaris is the terminal segment of the spinal cord, typically located between the first and second lumbar vertebrae (L1–L2). In this region, the central and peripheral nervous systems functionally merge, meaning injuries can impair lower limb motor and sensory functions as well as autonomic control of vital functions like urination, defecation, and sexual activity. Conus medullaris injuries often result from car accidents, falls, or violent trauma and account for more than 50% of spinal injuries involving the spinal cord-root junction.

The Case Study

The subject of the study is a 33-year-old man who suffered a severe spinal cord injury at the lower thoracic level (T11–T12) four years ago, resulting in paralysis of the lower limbs. Although classified as "incomplete" (ASIA Grade C), the injury severely affected his mobility. Despite two intensive rehabilitation programs following the trauma, the patient remained unable to stand or walk. Tests also showed damage to the nerve roots connecting the spinal cord to the leg muscles (L4–S1), indicating involvement of both the central and peripheral nervous systems—making this a particularly challenging case to treat, as conventional therapies rarely succeed when neural circuits are impaired at multiple levels. To provide a new 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 stimulation system with 32 electrodes between T11 and L1," explained Professor Pietro Mortini. "Once activated, the stimulation re-engaged residual neural circuits, particularly those controlling trunk muscles and hip flexors—key for regaining posture and walking ability. After an initial calibration phase, the patient underwent an innovative rehabilitation program integrating virtual reality exercises using sensory and motor feedback."

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