Stimulation-Associated Motor and Functional Improvement After Epidural Spinal Cord Stimulation in Chronic Spinal Cord Injury Secondary to Spinal Ependymoma: A Case Report

Abstract

Context: Chronic spinal cord injury (SCI) secondary to spinal tumors may cause persistent motor and sensory dysfunction despite surgical treatment and rehabilitation. Ependymomas are the most common intramedullary spinal tumors in adults, but long-standing neurological deficits after tumor surgery are difficult to treat. Findings: We report a 51-year-old man with chronic SCI after thoracic spinal ependymoma surgery performed in 2000. He had persistent right-predominant lowerextremity weakness, sensory loss below T10, limited walking endurance, and canedependent ambulation. EES was performed in October 2024 using a 32-contact paddle lead positioned over T12-L1. Motor-oriented programs were predominantly delivered at 40 Hz (approximately 3-4 mA; pulse width approximately 300 microseconds) and selected according to activity. The patient progressed from AIS C to AIS D, while SCIM III increased from 84 at baseline to 88, 96, 98, and 98 at 3, 6, 9, and 12 months, respectively. At the latest follow-up, AIS D was maintained with stimulation OFF and ON, while active stimulation provided additional facilitation of selected lower-extremity muscles, particularly ankle dorsiflexion. Conclusion/Clinical relevance: This case suggests that individualized EES may be associated with clinically meaningful motor and functional improvement even decades after SCI secondary to spinal ependymoma surgery. Longitudinal gains persisted with stimulation OFF, while stimulation ON provided additional taskdependent motor facilitation.