1143 - Jumpstarting Recovery: AIS B to C Conversion Following Early tSCS in High Cervical SCI

Case Diagnosis: High cervical spinal cord injury (SCI) often precipitates profound motor and sensory deficits, with arm and hand recovery being paramount priorities among individuals with tetraplegia. While transcutaneous spinal cord stimulation (tSCS) has demonstrated safety and efficacy in chronic SCI, its role in acute rehabilitation remains underreported.

Case Description:

A previously independent and active 42-year-old woman sustained a backward fall, necessitating C2–7 decompressive laminectomies and C1–T1 posterior fusion. At four weeks post-injury, she was admitted to inpatient rehabilitation (IPR) with no voluntary motor activity (classified C3 AIS B SCI). At six weeks, trace bilateral hip adductor activation appeared, prompting initiation of cervical and thoracic tSCS alongside daily 90-minute physical therapy. Stimulation used the RT300 device with alternating thoracic (T10–11) and cervical (C5–6) montages across eight sessions. Each session was well-tolerated without autonomic dysreflexia, skin breakdown, or other adverse events.

Discussions: The patient demonstrated accelerated neurologic and functional recovery after tSCS initiation. Sensory scores improved by 33 (light touch) and 14 (pin prick). Motor scores rose from 0 to 10. These exceeded thresholds for minimal clinically important difference in cervical AIS B injuries. Functional gains included improved unsupported sitting balance, voluntary bicep/tricep activation in gravity-eliminated planes, and increased engagement with adaptive technology. At discharge (10 weeks post-injury), she converted from AIS B to AIS C, showing new upper extremity activation and regaining voluntary anal contraction. Improvements temporally matched tSCS initiation and aligned with prior reports of neuromodulatory effects on motor and postural circuits.

Conclusions: This case illustrates feasibility, safety, and potential clinical impact of early tSCS during acute IPR for high cervical SCI. While spontaneous recovery cannot be excluded, the accelerated gains and AIS conversion suggest a modulatory effect warranting further investigation. As evidence accumulates, physiatrists may consider tSCS as a promising adjunctive strategy during the subacute neuroplastic window to optimize recovery.