The operation was performed at the San Raffaele hospital in Milan on a 32-year-old woman who was the victim of a sports accident that forced her into a wheelchair for five years
A woman with leg paralysis was able to regain movement through implantation of a medullary neurostimulator. The young woman, 32 years old, victim of a sports accident which caused a spinal cord injury, she is now able to stand and walk with the aid of a walker. The intervention, the first of its kind in Italy, was performed at the IRCCS San Raffaele Hospital in Milan (San Donato Group), by the team of neurosurgeons led by professor Pietro Mortinihead of Neurosurgery and full professor at the Vita – Salute San Raffaele University, in collaboration with a group of engineers from the Biorobotics Institute of the Scuola Superiore Sant’Anna in Pisa directed by Professor Silvestro Micerainternationally renowned expert.
The latter are the same, to be clear, who have collaborated with the group of the Polytechnic University of Lausanne (Epfl), led by professor Grgoire Courtine, in the experiment with which at the end of 2021 three paralyzed people had returned to walking, swimming and cycling thanks to electrodes implanted in the spinal cord. Last 24 May, then, Professor Courtine’s team was the protagonist of a further, astounding, result which allowed a Gert-Jan Oskam, 40 years old who was paralyzed 12 years ago in a bicycle accident, to walk naturally again, albeit for short distances and with the help of a crutch, thanks to a new technique described in the scientific journal Nature.
Brilliant results after four weeks
In Italy, the protocols for experimentation do not yet allow for neurostimulation for cervical lesions (like the one suffered by Oskam, ndr) – explains Professor Mortini – . Hospital Ethics Committees authorize the procedure only for the “lower” lesions. The implanted device is similar to what is used in pacing therapy for chronic pain. Furthermore, we have the possibility of programming it in such a way as to obtain brilliant results: after four weeks the patient is walking, with the aid of a walker. The woman is still performing with excellent results, a complex rehabilitation process defined by Sandro Iannacconehead of the Cognitive-motor neurological disorders Rehabilitation Unit.
What is the intervention?
The implanted device consists of two parts: a biocompatible holder for 32 electrodes which is inserted into the epidural space of the spine, and a pulse generator (a sort of pacemaker) similar to those used in patients with cardiac arrhythmias, introduced under the skin at hip level. The impulses are delivered to the spinal cord from where they then travel to the nerves and muscles.
The device was implanted in about 3 hours, through a delicate minimally invasive neurosurgical procedure, performed under continuous neurophysiological monitoring. The pacemaker was then programmed to ensure coordinated activation of all the muscles needed for walking. The control of the functions of the stimulator is possible thanks to a series of functional options that can be chosen by the patient based on the locomotor needs of daily life.
The quality of life after surgery
So far, the path described from a technical point of view. But what happens to a patient who undergoes a similar procedure? What is his quality of life? As mentioned – replies the head of neurosurgery of the San Raffaele -, patients must first face a particular rehabilitation program in successive stages: walking on a flat surface, then climbing the stairs and so on. And the stimulators are “set” for this very purpose. So there is a dependency, so to speak, on external software, which by now is becoming more and more elaborate and more and more sophisticated. Even the miniaturized device. The quality of life, therefore, is certainly better than before: let’s not forget that. in our case, a 32-year-old person in a wheelchair for five years can now walk.
Psychological assistance and diet
It is therefore a long and delicate path, which requires a multidisciplinary approach. In addition to neurosurgeons, engineers and rehabilitators, professionals who deal with psychological and nutritional aspects are also involved. Sometimes patients need to be assisted from this point of view as well. We we have equipped ourselves and offer them the support they may needadds Professor Mortini.
Future developments
What will happen now? Professor Piero Mortini explains: We are leading an advanced clinical research protocolcoordinated by my collaborator, Dr Luigi Albanoat the end of which this intervention could enter current clinical practiceoffering a therapeutic solution to patients with spinal cord injuries.
The next step – he clarifies – will be also treat spinal cord injuries caused by neurodegenerative diseases, such as multiple sclerosisin patients who will be recruited by the Neurology Unit of the IRCCS San Raffaele Hospital, directed by professor Massimo Filippi. This protocol is part of an advanced research program that Universit Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele have activated to develop innovative therapies who make use of an interface between electronic devices and the central nervous system to compensate for functional deficiencies.
The importance of training
But there is also another fundamental aspect to take into account. We are at the beginning of a road that can lead to great results relatively quickly with a tested technology and sustainable costs. If I see a critical issue in the future, it is not technological development, I am extremely optimistic about this, but “human capital”: we need engineers, rehabilitators, people who then assist patients and therefore basic training. Universities and research institutes take years to get qualified people. This is a large-scale project. It is therefore necessary also create specific training programmes for all this new chapter of Neurosurgery that is opening, concludes Professor Mortini.
May 30, 2023 (change May 30, 2023 | 10:06)
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