In one video she can be seen getting up from her chair and walking quite quickly and safely with the help of a walker. With her legs connected to electrodes, she crosses the room in less than twenty seconds and the video stops here. What appears to be a normal, everyday operation is actually an extraordinary feat for the 32-year-old protagonist of the images. Because of one detail: the woman has been paralyzed in her lower limbs for 5 years, ever since she was the victim of a sports accident that caused a spinal cord injury.
Today, thanks to a neurostimulator that was implanted in the San Raffaele hospital in Milan (San Donato group), she is able to walk again, recovering her motor functions. It is, they explain from the Irccs in via Olgettina, the “first intervention in Italy” of this type. An operation that bears the signature of the team of neurosurgeons led by Pietro Mortini, head of neurosurgery and full professor at the Vita-Salute San Raffaele University.
The young patient is now able to stand upright and walk with the aid of the walker. The result was possible thanks to the collaboration with the group of engineers of the Biorobotics Institute of the Sant’Anna School of Advanced Studies in Pisa, directed by Silvestro Micera, an internationally renowned expert in this field. The patient is still carrying out “with excellent results”, they say from the hospital, a complex rehabilitation process defined by Sandro Iannaccone, head of the Rehabilitation Unit for motor-cognitive neurological disorders. “The next step – explains Mortini – will also be to treat spinal cord injuries caused by neurodegenerative diseases, such as multiple sclerosis, in patients who will be recruited by the Neurology Unit of the San Raffaele hospital, directed by Professor Massimo Filippi”.
What is underway at the moment, explains Mortini, is “an advanced clinical research protocol, coordinated by my collaborator, Luigi Albano, at the end of which this intervention could enter current clinical practice, offering a therapeutic solution to patients with marrow”. This protocol is part of an advanced research program that the Vita-Salute San Raffaele University and Irccs San Raffaele have activated to develop innovative therapies that make use of an interface between electronic devices and the central nervous system to compensate for functional deficiencies.
The medullary neurostimulator implanted in the 32-year-old consists of two parts: a biocompatible support 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, inserted under the skin at the hip. The impulses are delivered to the spinal cord from where they then travel to the nerves and muscles.
The implantation of the device took place 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 on the basis of the ‘locomotor’ needs of daily life.