Surgical technique for installing an eight-channel neuroprosthesis for standing

A standardized surgical procedure to implant an eight-channel functional ne uromuscular stimulation system in the lower extremities for standing, exerc ise, and transfers for individuals with spinal cord injury has been develop ed. The implanted components include: (1) one eight-channel receiver-stimul ator, (2) epimysial electrodes, (3) intramuscular electrodes, and (4) inlin e connectors, The development process included identifying the target muscl e set for electrode placement and the corresponding surgical approaches, de termining the stages of the surgical procedure, and assessing the effective ness and stability of the implanted neuroprosthesis, The bilateral muscle s et consists of the vastus lateralis, the gluteus maximus, the semimembranos us, and the erector spinae, Surgical approaches to the nerve entry points w ere developed through a series of cadaveric studies and intraoperative test s. Electrode placement is related to bony landmarks and based on standard o rthopaedic approaches, The components of the neuroprosthesis are installed in one surgical session, with three stages, This procedure has been applied successfully in seven individuals, resulting in strong, isolated stimulate d contractions adequate to raise and lower the body, maintain standing with a walker, and perform pivot transfers, The standardized surgical procedure is repeatable and teachable and will be used in upcoming multicenter clini cal trials of the implanted neuroprosthesis.