Laparoscopic implantation of neuromodulators for treating bladder and lower limb spasticity and promoting micturition in spinal cord injured patients

Introduction: Pelvic organ autonomic disorders and lower limb spasticity and atrophy are among the most important factors affecting morbidity and quality of life of thoracic spinal cord injured patients. Recently, the laparoscopic implantation of neuroprosthesis (LION) is figuring as a possibly more specific and selective treatment for these affections. Objective: evaluate the effect of the LION procedure at on bladder and rectal function and lower limb spasticity and contractility, to promote an alternative locomotion to thoracic spinal cord injured patients. Methods: we report our first case of a LION procedure. The patient is a 29 year-old man, with C7-Th1 (neurological Th3) car spinal cord injury since age 18 years, classified as grade B (ASIA), only due to rudimentary anal sensitiveness. Electrodes were implanted juxtaneurally to the pudendal, sciatic and femoral nerves. Results: at one month follow-up bladder spasticity was completely resolved and bladder capacity doubled (190mL pre-op to 380mL post-op). Moreover, the patient was able to extend the knee from postoperative day one. Thirty-two days after surgery, the right femoral nerve electrode was misplaced, requiring a reintervention and postponed the standing up training. At twomonths follow-up thighs circumference increased from 38.5 cm (right) and 42 cm (left) to 40 cm (right) and 42 cm (left), he is showing some voluntary pelvic floor contraction, sensitivity improved on Th4 to Th11 and L2 to S4 dermatomes with the stimulator turned on and on Th4 and Th5 with it turned off. The stand up and walking training is planned to start at post-operative three months, in January. Conclusion: The LION procedure offers new target nerves for modulation and is a promising method for motor and urologic rehabilitation in spinal cord injured patients.