The "Possover-LION Procedure" to the Pelvic Somatic Nerves in People With a Spinal Cord Injury.

OBJECTIVE:To demonstrate the technique of laparoscopic implantation of neuroprosthesis to the pelvic somatic nerves for recovery of voluntary walking motion in some patients with chronic spinal cord injuries. DESIGN:Video. SETTING:Tertiary referral unit specialized in advanced gynecologic surgery and neuropelveology. INTERVENTIONS:The technique of laparoscopic implantation of electrodes on the pelvic nerves-the LION (Laparoscopic Implantation of Neuroprothesis) procedure-was introduced by Possover in gynecology more than 15 years ago for the treatment of refractory pelvic neuropathic pain and bladder dysfunctions. From this first indication, further applications were developed, especially in the field of parapleology. The "Possover-LION" procedure consists of a laparoscopic implantation by transperitoneal approach of 4 stimulation lead electrodes to the sciatic, pudendal, and femoral nerves on both sides in those with a spinal cord injury. The femoral nerves are identified laterally to the psoas muscles, whereas exposure of the sciatic and pudendal nerves is obtained by blunt dissection of the lumbosacral space, laterally to the external iliac vessels. The lead electrodes are simply placed in direct contact to the nerves, while the retroperitoneal loop of cables prevents from dislocation. Finally, all cables are connected to a multichannel generator implanted in paraumbilical position, fixed to the abdominal fascia. CONCLUSION:The LION procedure allows the stimulation of the pelvic somatic nerves for recovery of a voluntary electrically assisted walking motion in approximately 70% of patients with chronic complete or incomplete spinal cord injury.