Percutaneous implantation of iliopsoas for functional neuromuscular stimulation

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.