Lumbar enlargement spinal cord stimulation for severe spasticity and motor function improvement after traumatic brain injury: a case report

This case report describes the successful use of epidural spinal cord stimulation (SCS) in managing severe, refractory spasticity in a 58-year-old male following traumatic brain injury. Despite nearly 8 months of conventional pharmacotherapy and rehabilitation for his tetraplegia, his lower-limb spasticity persisted at Modified Ashworth Scale (MAS) grade 3, severely impeding functional recovery. After implantation of a trial and subsequently permanent SCS system at the lumbar enlargement, muscle tone decreased to MAS grade 2 within 48 h, alongside improvements in muscle strength. Over 6 months, stimulation led to a marked reduction in the frequency and severity of spastic episodes. This spasticity relief fundamentally improved the patient's sleep quality and enabled significant functional gains, including assisted standing and pedal stepping. This case demonstrates the positive effect of SCS for a condition often resistant to standard treatments. The results support re-evaluating SCS's therapeutic potential for refractory spasticity caused by TBI and other central nervous system disorders, potentially through mechanisms involving the modulation of spinal cord excitability.