Spinal fusion for the management of lumbar degenerative disc disease has been available for several decades. The results of this procedure remain under constant scrutiny and progressive development. Anterior lumbar fusion was initially introduced in the early 1920s. Fibula and iliac struts, femoral rings and dowel, as well as synthetic metallic devices, have been applied as fixation implements to aid in lumbar interbody fusion. The new technique, details of which are reported in the Journal of Neurotrauma, is believed to represent the first time patients have regained voluntary leg movement without the need for invasive treatments such as surgery.
Instead, scientists utilized electrical stimulation therapy and physical rehabilitation exercises to treat patients. Senior author Prof. V. Reggie Edgerton hopes these findings will enable scientists to look at spinal cord injuries "in a new way," offering hope to millions of people with paralysis. Roderick Pettigrew, director of the National Institute of Biomedical Imaging and Bioengineering at the National Institutes of Health (NIH), echoed this view and believes spinal cord injuries may no longer be "a life sentence of paralysis." He says:
The potential to offer a life-changing therapy to patients without requiring surgery would be a major advance; it could greatly expand the number of individuals who might benefit from spinal stimulation.
This is not the first time Prof. Edgerton has investigated how paralysis can be alleviated. Last year, he and his research team investigated paralysis in four men. Each was paralyzed from the waist down for years but were able to move from their hips to their toes following epidural electrical stimulation of their spinal cords. Stimulation was elicited by a device called an epidural stimulator, which needed to be surgically implanted into the patient's spinal cord.
Encouraged by these results, Prof. Edgerton and colleagues pressed on and earlier this year, researchers demonstrated involuntarily stepping movements could be induced in uninjured patients without the need for surgery. It was this reaction that served as the catalyst for the researchers to see if the same noninvasive method could be applied to patients suffering from paralysis.
In the most recent study, five men - each completely paralyzed from the waist down for more than 2 years - underwent a 45-minute training session per week for 18 weeks. Electrodes were placed on a patient's skin on their lower back, which administered a unique pattern of electrical currents. This caused no discomfort to the patients and no surgery was required.
At the beginning of the study, the patient's legs only moved when the stimulation induced was strong enough to generate involuntary step-like movements. As the study went on, the men attempted to move their legs further while receiving stimulation and the range of movement significantly increased.