Prague, September 2, 2022 – Doctors at the Faculty Hospital in Motola were the first in the Czech Republic to use the epidural spinal cord stimulation method in a 32-year-old patient with a spinal cord injury. An electrode placed in the lower part of the spinal cord under the damaged area stimulates the muscles of the lower limbs, activates them and causes movement.
Spinal cord stimulation has been used for 50 years to treat chronic intractable pain. Through an electrode introduced into the spinal canal connected to a generator of electrical impulses, the posterior spinal roots are stimulated, which leads to a reduction in the perception of pain. Gradually, this method also began to be used in patients after a spinal cord injury. Scientists in the United States have found that if an electrode is placed in the area where the nerves connected to the muscles of the lower limbs depart from the spinal cord, it is possible to activate these muscles through stimulation and thus cause movement of the limb. Thus, the stimulation takes place below the level of the original spinal cord lesion, in an area that is not functionally damaged, but no signals from higher centers can enter it.
In the last twenty years, works have been repeatedly published that describe the use of epidural spinal cord stimulation to restore standing and walking for a shorter distance, even in patients who had a complete loss of movement of the lower limbs after a spinal cord injury. The discovery that some of them regained active (will-controlled) limb movement after several months of stimulation is also revolutionary.
At the workplace of the Spinal Unit at the Clinic of Rehabilitation and Physical Education of the 2nd Faculty of Medicine of the University of Warsaw and the Motol University of Medical Sciences, after several months of preparation, in cooperation with the Neurosurgery Clinic of the 2nd University of the University of Warsaw and the Motol University of Medical Sciences and the Center for the Treatment and Research of Painful Conditions, the epidural spinal cord stimulation project was launched.
"For the first spinal cord stimulation, we indicated a 32-year-old patient with a complete spinal cord lesion after a fracture of the 4th and 5th thoracic vertebra, caused by a fall on a bicycle three years ago," states doc. MD Jiří Kříž, Ph.D., head of the Spinal Unit at the Clinic of Rehabilitation and Physical Education Medicine of the 2nd Faculty of Medicine of the University of Warsaw and the Motol Medical University.
"We introduced the electrode under X-ray control, its placement was relatively complex, as it must be accurate not only in terms of height, but also in terms of lateral deviations," explains operator doc. MD RNDr. Ondřej Bradáč, Ph.D., head of the Children's and Adult Neurosurgery Clinic of the 2nd Faculty of Medicine of the University of Warsaw and Motol University of Applied Sciences.
On the third day after neurostimulator implantation, stimulation of various muscle groups of the lower limbs was started in relaxed positions on the back and on the side. Stimulation parameters for movement against gravity and active muscle support while standing were gradually adjusted for the patient.
"Long-term rehabilitation will now take place with the aim of stimulating even more complex muscle interactions and using stimulation for active standing, ideally also for shorter walking with aids," adds the primary Kříž.
"When the system is turned on, I feel that there is some movement, even if only minimally so far, we will see in time if the response improves. At the very least, it allows me to rehabilitate parts of my body that I can't feel and move, which is great in the long run if I want to maintain muscle function." says the first operated patient, Mr. Mikuláš.
The University Hospital in Motola is the largest medical facility in the Czech Republic and one of the largest in Europe. It is also the main teaching base for students of the 2nd Faculty of Arts of the UK and also houses some workplaces of the 1st Faculty of Arts of the UK. FN Motol provides basic, specialized and super-specialized health care and services in medical fields in the form of outpatient and inpatient care for children, adults and seniors. Structurally, it consists of two interconnected monoblocks (children's and adult parts) and several separate pavilions. In FN Motol, more than one million patients are treated annually in 56 clinics.
doc. MD Jiří Kříž, Ph.D., e-mail: email@example.com
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Press release for download: Epidural spinal cord stimulation - a method that can enable paraplegic patients to stand up (371 KB)