Spinal Cord Stimulation Combined With Motor Training in Non-Traumatic SCI: A Prospective Interventional Study (Neuro-scs-002)
Evaluation of Spinal Cord Stimulation Assisted by Motor Rehabilitation Training for Restoring Motor Function in Non-traumatic Spinal Cord Injury: an Interventional, Prospective, Monocentric Study
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Milan, Italy, 20132
- IRCCS Ospedale San Raffaele
-
Principal Investigator:
- Pietro Mortini, MD
-
Contact:
- Luigi Albano, MD, PhD
- Phone Number: +39 0226435568
- Email: albano.luigi@hsr.it
-
Principal Investigator:
- Luigi Albano, MD, PhD
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Diagnosis of NTSCI at least one year before presentation;
- Complete or incomplete spinal cord damage (ASIA grade A, B or C) conditioning chronic neuropathic pain and motor impairment;
- Age ≥ 18 years;
- Indication to spinal cord stimulation surgery for chronic pain;
- Being unable to stand or step independently;
- No current anti-spasticity medication regimen;
- No botox injections in the prior 3 months;
- Evidence of a personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study;
- Willingness and ability to comply with scheduled visits and other trial procedures.
Exclusion Criteria:
- Any person unable to lie still within the environment of the MRI scanner for the required period to perform the study and those where MRI scanning is contraindicated;
- Pregnancy or breastfeeding;
- Any significant psychiatric disease;
- Use of illicit drugs;
- Unstable medical condition without cardiopulmonary disease or dysautonomia that would contraindicate standing or stepping;
- Painful musculoskeletal dysfunction, unhealed fracture, contracture, pressure sore, or urinary tract infection that might interfere with stand or step training;
- Spinal cord involvement above the D1 segment;
- Severe peripheral neuropathies or damage to the cauda equine.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Individuals with functionally complete/incomplete non-traumatic spinal cord injury
Individuals with functionally complete/incomplete non-traumatic spinal cord injury who will undergo SCS for chronic pain
|
The first part of the study will involve a preoperative evaluation.
Participants' clinical history, neurological, neurophysiological and advanced brain/spine MRI examination will be assessed (Part 1).
Subsequently, participants will undergo spinal cord stimulation surgery which involves the implantation of a medical device (Part 2).
After the surgery, the research participants will be hospitalized at the Neurosurgery Unit (5-14 days) to monitor the incision site (Part 3).
Thereafter, the patients will be moved (for at least 6 weeks) to the Rehabilitation Unit in order to identify appropriate stimulation parameters for inducing stepping and standing and for starting training.
The combination of epidural stimulation with manual step/stand training will be thus evaluated (Part 4).
Patients will be finally assessed by clinical evaluation, advanced MRI and neurophysiological examination to study the brain, spine and peripheral functions after six months (Part 5).
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Motor changes (MRC)
Time Frame: Before surgery, then monthly up to 6-month from surgery
|
The Medical Research Council's (MRC) scale of muscle power will be used to evaluate motor weakness.
The MRC scale of muscle strength uses a score from Grade 5 (normal) to Grade 0 (no visible contraction) to assess the power of a particular muscle group in relation to the movement of a single joint.
|
Before surgery, then monthly up to 6-month from surgery
|
|
Motor changes (LEFS)
Time Frame: Before surgery, then monthly up to 6-month from surgery
|
The Lower Extremity Functional Scale (LEFS) will be used by clinicians as a measure of lower extremity function.
It is a questionnaire containing 20 questions about a person's ability to perform everyday tasks (minimum score 0, maximum score 80).
|
Before surgery, then monthly up to 6-month from surgery
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Spasticity changes
Time Frame: Before surgery, then monthly up to 6-month from surgery
|
The Modified Ashworth scale will be used to evaluate spasticity.
This scale grades the muscle tone from 0 (normal) to 4 (severe spasticity).
|
Before surgery, then monthly up to 6-month from surgery
|
|
Longitudinal neurophysiological reorganization (electromyography)
Time Frame: Before surgery and 6 months after procedure
|
Electromyography will be used to evaluate muscle response or electrical activity in response to a nerve's stimulation.
|
Before surgery and 6 months after procedure
|
|
Longitudinal neurophysiological reorganization (motor evoked potentials)
Time Frame: Before surgery and 6 months after procedure
|
Motor evoked potentials will be used to evaluate electrical signals recorded from the descending motor pathways or from muscles following stimulation of motor pathways within the brain.
|
Before surgery and 6 months after procedure
|
|
Longitudinal neurophysiological reorganization (sensory evoked potentials)
Time Frame: Before surgery and 6 months after procedure
|
Sensory evoked potentials will be used to assess electrical activity in the brain in response to sensory stimulation.
|
Before surgery and 6 months after procedure
|
|
Longitudinal brain and spine MRI reorganization
Time Frame: Before surgery and 6 months after procedure
|
Structural and functional brain and spine MRI analysis.
|
Before surgery and 6 months after procedure
|
|
Chronic pain changes (MPQ)
Time Frame: Before surgery and 6 months after procedure
|
The McGill Pain Questionnaire (MPQ) can be used to evaluate a person experiencing significant pain.
It consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe.
|
Before surgery and 6 months after procedure
|
|
Chronic pain changes (PCS)
Time Frame: Before surgery and 6 months after procedure
|
The Pain Catastrophizing Scale (PCS) assesses the extent of catastrophic thinking.
It assesses the extent of catastrophic thinking due to low back pain according to 3 components: rumination, magnification, and helplessness.
It is a 13-item scale, with a total range of 0 to 52.
Higher scores are associated with higher amounts of pain catastrophizing.
|
Before surgery and 6 months after procedure
|
|
Chronic pain changes (ASC-12)
Time Frame: Before surgery and 6 months after procedure
|
12-item Allodynia Symptom Checklist (ASC-12) evaluates presence of allodynia and hypoesthesia.
|
Before surgery and 6 months after procedure
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Publications and helpful links
General Publications
- Angeli CA, Boakye M, Morton RA, Vogt J, Benton K, Chen Y, Ferreira CK, Harkema SJ. Recovery of Over-Ground Walking after Chronic Motor Complete Spinal Cord Injury. N Engl J Med. 2018 Sep 27;379(13):1244-1250. doi: 10.1056/NEJMoa1803588. Epub 2018 Sep 24.
- Wagner FB, Mignardot JB, Le Goff-Mignardot CG, Demesmaeker R, Komi S, Capogrosso M, Rowald A, Seanez I, Caban M, Pirondini E, Vat M, McCracken LA, Heimgartner R, Fodor I, Watrin A, Seguin P, Paoles E, Van Den Keybus K, Eberle G, Schurch B, Pralong E, Becce F, Prior J, Buse N, Buschman R, Neufeld E, Kuster N, Carda S, von Zitzewitz J, Delattre V, Denison T, Lambert H, Minassian K, Bloch J, Courtine G. Targeted neurotechnology restores walking in humans with spinal cord injury. Nature. 2018 Nov;563(7729):65-71. doi: 10.1038/s41586-018-0649-2. Epub 2018 Oct 31.
- Gill ML, Grahn PJ, Calvert JS, Linde MB, Lavrov IA, Strommen JA, Beck LA, Sayenko DG, Van Straaten MG, Drubach DI, Veith DD, Thoreson AR, Lopez C, Gerasimenko YP, Edgerton VR, Lee KH, Zhao KD. Neuromodulation of lumbosacral spinal networks enables independent stepping after complete paraplegia. Nat Med. 2018 Nov;24(11):1677-1682. doi: 10.1038/s41591-018-0175-7. Epub 2018 Sep 24.
- Romeni S, Losanno E, Emedoli D, Albano L, Agnesi F, Mandelli C, Barzaghi LR, Pompeo E, Mura C, Alemanno F, Tettamanti A, Castellazzi P, Ciucci C, Fossati V, Toni L, Caravati H, Bandini A, Del Carro U, Agosta F, Filippi M, Iannaccone S, Mortini P, Micera S. High-frequency epidural electrical stimulation reduces spasticity and facilitates walking recovery in patients with spinal cord injury. Sci Transl Med. 2025 Jan 8;17(780):eadp9607. doi: 10.1126/scitranslmed.adp9607. Epub 2025 Jan 8.
- Albano L, Emedoli D, Agnesi F, Romeni S, Losanno E, Toni L, Fossati V, Ciucci C, Gasperotti F, Cociani L, Zucco G, Pompeo E, Mura C, Carpaneto J, Tettamanti A, Castelnovo V, Padul JD, Mandelli C, Barzaghi LR, Alemanno F, Caravati H, Butera C, Del Carro U, Castellano A, Falini A, Agosta F, Filippi M, Iannaccone S, Mortini P, Micera S. Epidural electrical stimulation facilitates motor recovery in spinal cord injury involving the conus medullaris: A case study. Med. 2025 Oct 10;6(10):100706. doi: 10.1016/j.medj.2025.100706. Epub 2025 May 27.
Study record dates
Study Major Dates
Study Start (Estimated)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pain
- Neurologic Manifestations
- Musculoskeletal Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Muscular Diseases
- Muscle Hypertonia
- Neuromuscular Manifestations
- Wounds and Injuries
- Trauma, Nervous System
- Pathological Conditions, Signs and Symptoms
- Signs and Symptoms
- Muscle Spasticity
- Chronic Pain
- Spinal Cord Injuries
- Spinal Cord Diseases
- Equipment and Supplies
Other Study ID Numbers
Other Study ID Numbers
- Neuro-scs-002
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Spinal Cord Disease
-
NCT01973257CompletedSpinal Cord Injury, Degenerative Spinal Disease.
-
NCT06981338Not yet recruitingSpinal Cord Injury | Spinal Cord Disease | Spinal Cord Injuries (SCI) | Traumatic Spinal Cord Injuries
-
NCT06698224Not yet recruitingSpinal Cord Injury | Spinal Cord Disease | Spinal Cord Injuries (SCI)
-
NCT07364773RecruitingSpinal Cord Disease | Spinal Cord Injuries (SCI)
-
NCT02885870Completed
-
NCT03033212CompletedDegenerative Spinal Cord Disease
-
NCT06293157RecruitingMetastasis Spine | Metastatic Spinal Cord Compression
-
NCT01367405TerminatedCentral Spinal Cord Syndrome
-
NCT07234903RecruitingChronic Spinal Cord Injury | Spinal Cord Injury (SCI) | Spinal Cord Injury | SCI - Spinal Cord Injury | SCI | Subacute Spinal Cord Injury
-
NCT05530798CompletedSpinal Cord Diseases | Spinal Stenosis | Spinal Cord Injuries | Spine Degeneration | Spinal Cord Compression | Spine Disease | Spinal Injury
Clinical Trials on Spinal cord stimulation surgery (device implant) and motor rehabilitation
-
NCT05926843Recruiting
-
NCT03546738CompletedPain, Postoperative | Back Pain With Radiation
-
NCT06421350RecruitingComplex Regional Pain Syndromes
-
NCT07579611Not yet recruitingNeuropathic Pain | Chemotherapy-induced Peripheral Neuropathy (CIPN) | Cancer-related Pain
-
NCT05150002TerminatedSubarachnoid Hemorrhage | Cerebral Vasospasm
-
NCT06585033RecruitingChronic Postoperative Pain
-
NCT05704751RecruitingBack Pain Lower Back Chronic | Spinal Cord Stimulation
-
NCT04732325CompletedChronic Pain | Complex Regional Pain Syndromes | Neuropathic Pain | Failed Back Surgery Syndrome
-
NCT07511244RecruitingSCI - Spinal Cord Injury | Bladder and Bowel Dysfunction