Walking again after spinal cord injury, a unique case in the world at San Raffaele in Milan

A 33-year-old paraplegic patient walks again thanks to a neurostimulator , after a serious spinal cord injury paralyzed his legs four years ago. Andrea is the protagonist of a unique clinical case, published in 'Med - Cell Press' by a multidisciplinary team of the Mine Lab composed of doctors, physiotherapists and researchers from the IRCCS San Raffaele hospital in Milan and the Vita-Salute San Raffaele university, together with bioengineers from the Scuola Superiore Sant'Anna in Pisa coordinated by Silvestro Micera.

The study

Luigi Albano, neurosurgeon and researcher at San Raffaele, is the first author of the study that describes the "incredible recovery" of the young man, immobilized by "a traumatic spinal cord injury at the lower thoracic level (T11-T12) extending to the conus medullaris, the terminal portion of the spinal cord". An accident at work had caused him "a serious motor deficit due to damage to both the central and peripheral nervous system", they explain from via Olgettina. "The researchers, after surgically implanting a spinal neurostimulator in the epidural space, applied specific stimulation and rehabilitation protocols, significantly improving muscle strength, walking and motor control".

The work - a note explains - is part of a research path started with the first implantation of a spinal neurostimulator in 2023, performed by a team led by Pietro Mortini, head of Neurosurgery at San Raffaele and full professor of Neurosurgery at the Vita-Salute University. The path continued with the publication, in 'Science Translational Medicine' in 2025, of the first results obtained on 2 implanted patients that demonstrate the effectiveness of the innovative protocol of epidural electrical stimulation (Epidural Electrical Stimulation, Ees) in the treatment of spinal cord injuries.

"With this case study - says Albano - we have demonstrated, for the first time, the effectiveness of Ees epidural electrical stimulation supported by rehabilitation in restoring motor functions of the lower limbs in a patient affected by paraplegia due to a severe lesion extending to the conus medullaris, allowing him to reach the upright position and walk for short distances. In addition to motor recovery, the stimulation has determined a clinically relevant improvement in neuropathic pain and in the overall quality of life of the patient", adds the neurosurgeon. "The results of this study - says Mortini - offer new hope to patients with severe spinal cord injuries who have experienced a long period of immobility, offering the possibility of recoveries unthinkable until recently thanks to the integration of advanced neuromodulation and personalized rehabilitation".

Spinal cord injury and electrode stimulation

The conus medullaris is the final part of the spinal cord, located approximately between the first and second lumbar vertebrae (L1-L2). In this area, the central nervous system functionally merges with the peripheral nervous system, so a lesion in this region can compromise both the motor and sensory functions of the lower limbs and the autonomic control of vital functions such as urination, defecation and sexuality, doctors explain. Traumas of the conus medullaris can be caused by car accidents, falls or violent events, and represent a significant share - over 50% - of spinal injuries that involve the junction between the cord and spinal roots.

"Due to the anatomical and functional complexity of this area - Albano highlights - these lesions are among the most difficult to treat and often involve a combination of paraplegia, severe neuropathic pain and sphincter disorders. The clinical picture can vary from patient to patient, but in most cases severe and persistent motor and sensory deficits are observed that have a profound impact on the quality of life and autonomy. Traditional therapeutic options are limited and focus mainly on rehabilitation, but the recovery margins are generally modest. It is in this context that the application of epidural electrical stimulation represents a potential turning point, opening up new treatment perspectives even for the most complex lesions".

Injuries like Andrea's. Classified as 'incomplete' (grade C according to the American Spinal Injury Association's Asia scale), it had however profoundly compromised his ability to move. Despite 2 intensive rehabilitation cycles carried out after the accident, the young man was no longer able to walk or stand . The tests had also revealed damage to the nerve roots that connect the spinal cord to the leg muscles (from L4 to S1), a sign that, in addition to the central nervous system, the peripheral nervous system was also involved. A condition described as particularly difficult to treat, because traditional therapies rarely give results when the nervous circuits are damaged at multiple levels. To offer a new possibility, the patient was included in the Neuro-SCS-001 clinical trial that evaluates the effects of epidural electrical stimulation combined with a personalized rehabilitation program.

"We implanted a spinal stimulation system with 32 electrodes , positioning it between T11 and L1 - reports Mortini - The stimulation, once activated, allowed us to rekindle some residual nervous circuits, in particular those that control the trunk muscles and hip flexors, essential for recovering posture and walking. After an initial calibration phase, the patient followed an innovative rehabilitation program that integrates exercises in a virtual reality environment, using sensory and motor feedback".

The rehabilitation program

Thanks to the innovative rehabilitation program followed by the physiotherapists of San Raffaele, "the improvements were surprising", we read in the note. "In just three months - reports Daniele Emedoli, physiotherapist researcher of the Neurological-cognitive-motor disorders Rehabilitation Unit of the IRCCS of Milan - the patient showed a significant increase in the hip joint excursion, with a consequent strengthening of the mobility of the lower limbs; he also improved the postural control of the trunk in a sitting position, allowing the movement of the center of gravity without loss of balance; finally, an increase in the angle of flexion of the trunk was observed, detectable exclusively with the active stimulator".

Over time, Andrea gradually reduced the support needed to walk: from exercises on a treadmill with unloading of body weight, he moved on to walking with the aid of a walker and braces. Upon discharge, he was already able to walk 58 meters in 6 minutes and complete the 10-meter test in just over 40 seconds, and six months after the operation, the young man walked independently for 1 kilometer with only the aid of a walker and braces. On May 4, Andrea participated in the Milan edition of the Wings For Life World Run , an international charity event, the largest running event in the world.

"The success of this program demonstrates how essential teamwork is between physiotherapists, physiatrists, neurologists, neurosurgeons and engineers," comments Sandro Iannaccone, director of the Rehabilitation Department at San Raffaele. "Only thanks to close collaboration and a multidisciplinary approach, which integrates advanced neuromodulation techniques with technological and personalized rehabilitation - he emphasizes - has it been possible to achieve such significant results in the patient's motor recovery."

"People with spinal cord injuries who are interested in evaluating a diagnosis and treatment path with epidural electrical stimulation can contact the Irccs San Raffaele hospital," is the message that the facility sends to patients. "The multidisciplinary team composed of neurosurgeons, neurologists and physiotherapists evaluates each case in a personalized way, even in the context of ongoing clinical trials. For information, you can write to the e-mail address: [email protected]".