Hip flexion is required for walking and stair climbing. Percutaneous electr
ical stimulation of the iliopsoas muscle is a potentially useful and reliab
le method of providing hip flexion in individuals who are paralyzed. In thi
s study, groin, lateral abdominal, and paraspinal approaches of percutaneou
s electrode implantation for electrical stimulation of the iliopsoas muscle
are described. The paraspinal approach using stimulation of the second and
third lumbar roots gave the best hip flexion response; however, it often w
as accompanied by unwanted stimulation of the hip adductor and abdominal mu
scles. Wire breakage and electrode movement were the most common causes for
failure of maintaining hip flexion. The paraspinal approach, using double
helix electrodes, provided an average of 110 weeks of functional hip flexio
n sufficient for walking. It is feasible to implant electrodes in the iliop
soas muscle. An open technique for permanent implantation of intramuscular
electrodes is being developed to selectively stimulate the iliopsoas, which
will extend the range and duration of hip flexion that Rill allow stair cl
imbing in individuals who are paraplegic.