Neuromodulation : journal of the International Neuromodulation Society · 2026
Early Functional Change After Epidural Electrical Stimulation Combined With Structured Rehabilitation in Spinal Cord Injury With Conus-Region Involvement: An Exploratory Cohort Analysis.
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Baran Aslihan Cevik, Balkuv Ece, Yavas Arzu Dinc, Gonullu Edip, Onen Mehmet Serif, Serifoglu Luay, Sarioglu Seyma, Eker Emir, Acar Gorkem, Matis Georgios
Аннотация
OBJECTIVE: Spinal cord injury (SCI) involving the conus region may produce mixed upper motor neuron, lower motor neuron, sacral, and lumbosacral-root dysfunction. Evidence regarding epidural electrical stimulation (EES) in this anatomically complex subgroup remains limited. This study aimed to describe early functional changes after EES integrated with a standardized rehabilitation program in patients with SCI involving the conus region.
MATERIALS AND METHODS: This exploratory cohort was derived from a prospectively maintained clinical EES data base. Of the 30 eligible patients with SCI involving the T12 and/or L1 region, 29 completed Spinal Cord Independence Measure (SCIM; 0 = worst, 100 = best) assessments at baseline, three months, and six months. The primary outcome was the change in total SCIM score from baseline to six months. Secondary analyses included changes in SCIM subdomain. EES programming was individualized, whereas the rehabilitation program and assessment schedule were standardized. Longitudinal analyses were performed using nonparametric statistical methods.
RESULTS: Total SCIM increased from 49.3 ± 21.3 at baseline to 60.9 ± 19.3 at six months (mean change 11.6, 95% CI, 8.9-14.9; median change, 11 [interquartile range, 5-14]; Friedman p < 0.001). Sixteen of the 29 participants (55.2%; 95% CI, 37.5%-71.6%) achieved a ≥ ten-point increase. Mean zero- to six-month subdomain changes were 2.5 points for Self-Care, 5.6 points for Respiration and Sphincter Management, 1.4 points for Mobility: Room and Toilet, and 2.0 points for Mobility: Indoors and Outdoors. Detailed neurologic characterization was available for all 29 participants, with lower motor neuron/root involvement documented throughout the cohort. No major procedure- or device-related complications were observed during the six-month follow-up. Nondevice-related adverse events were managed conservatively and resulted in no permanent neurologic deterioration.
CONCLUSION: In this uncontrolled exploratory cohort, selected patients with SCI involving the conus region showed early functional improvement after EES was integrated with standardized rehabilitation. Improvements were observed across multiple SCIM domains, with the greatest mean contribution arising from Respiration and Sphincter Management. Because of the observational design and the absence of objective autonomic outcome measures, these findings should be regarded as hypothesis-generating and require confirmation in prospective controlled studies.
MATERIALS AND METHODS: This exploratory cohort was derived from a prospectively maintained clinical EES data base. Of the 30 eligible patients with SCI involving the T12 and/or L1 region, 29 completed Spinal Cord Independence Measure (SCIM; 0 = worst, 100 = best) assessments at baseline, three months, and six months. The primary outcome was the change in total SCIM score from baseline to six months. Secondary analyses included changes in SCIM subdomain. EES programming was individualized, whereas the rehabilitation program and assessment schedule were standardized. Longitudinal analyses were performed using nonparametric statistical methods.
RESULTS: Total SCIM increased from 49.3 ± 21.3 at baseline to 60.9 ± 19.3 at six months (mean change 11.6, 95% CI, 8.9-14.9; median change, 11 [interquartile range, 5-14]; Friedman p < 0.001). Sixteen of the 29 participants (55.2%; 95% CI, 37.5%-71.6%) achieved a ≥ ten-point increase. Mean zero- to six-month subdomain changes were 2.5 points for Self-Care, 5.6 points for Respiration and Sphincter Management, 1.4 points for Mobility: Room and Toilet, and 2.0 points for Mobility: Indoors and Outdoors. Detailed neurologic characterization was available for all 29 participants, with lower motor neuron/root involvement documented throughout the cohort. No major procedure- or device-related complications were observed during the six-month follow-up. Nondevice-related adverse events were managed conservatively and resulted in no permanent neurologic deterioration.
CONCLUSION: In this uncontrolled exploratory cohort, selected patients with SCI involving the conus region showed early functional improvement after EES was integrated with standardized rehabilitation. Improvements were observed across multiple SCIM domains, with the greatest mean contribution arising from Respiration and Sphincter Management. Because of the observational design and the absence of objective autonomic outcome measures, these findings should be regarded as hypothesis-generating and require confirmation in prospective controlled studies.