Beyond Pain Relief: Motor Effects of Spinal Cord Stimulation in Chronic Incomplete Spinal Cord Injury During Routine...

Background: Spinal cord injury (SCI) is associated with persistent motor impairment, neuropathic pain, and reduced quality of life. While spinal cord stimulation (SCS) is an established therapy for neuropathic pain, motor effects have largely been demonstrated in experimental settings with activity-based training protocols. Whether such effects can be achieved within routine clinical care remains unclear. Case Presentation: We report on motor effects after the clinical implementation of percutaneous SCS using a commercially available system in a patient with chronic, posttraumatic, incomplete thoracic SCI. Following a standard inpatient trial and implantation of two percutaneous leads for neuropathic pain, all subsequent management, programming, and rehabilitation were conducted in an outpatient setting. Task-specific stimulation programs were iteratively developed to support functional activities during routine rehabilitation. Lower-extremity muscle strength was assessed using standardized handheld dynamometry at baseline and at monthly intervals over six months under stimulation-ON and stimulation-OFF conditions. Results: Serial dynamometry showed early stimulation-associated increases in force generation, with higher values under stimulation-ON than stimulation-OFF conditions. Over time, absolute strength values under OFF conditions also increased across individual muscle measurements, while stimulation-associated ON-OFF differences became less pronounced during intermediate follow-up but remained evident at month six. These observations included both acute stimulation-associated differences in force generation and longitudinal improvements in OFF-state motor performance. Stimulation was well tolerated during daily use and successfully integrated into outpatient rehabilitation. Functional outcomes showed concordant improvements in ambulatory performance and patient-reported domains. No stimulation-related adverse effects were observed during follow-up. Conclusions: This case illustrates how clinically indicated percutaneous SCS can be combined with motor-oriented programming within routine outpatient rehabilitation. The observed stimulation-associated motor effects and longitudinal changes in stimulation-OFF strength are limited to this individual patient and cannot establish efficacy or causality. Prospective controlled studies are needed to determine the reproducibility and clinical relevance of these observations in chronic incomplete SCI.