Combined neuromodulation techniques via a central-peripheral-central strategy facilitate functional recovery from AIS A to AIS C in a patient with complete spinal cord injury: A case report

Context Complete spinal cord injury (SCI) has traditionally been considered irreversible. However, accumulating evidence suggests that subclinical neural pathways may persist. Multimodal combined neuromodulation targeting brain–spinal–peripheral circuits holds promise to unlock latent neural plasticity, but clinical evidence for its application in patients with clinically complete SCI remains limited.Findings A 53-year-old male with chronic complete T9 SCI (AIS A) received a sequential multimodal neuromodulation protocol consisting of spinal cord electrical stimulation (SCS), brain-computer interface (BCI) training, primary motor cortex intermittent theta-burst stimulation (iTBS), and peripheral magnetic stimulation (pMS) of the bilateral iliopsoas muscles, alongside 12 months of conventional rehabilitation. After one year of intervention, his neurological status improved from AIS A to AIS C (T9 to T12). The left lower limb motor score increased from 0 to 6, accompanied by the recovery of partial voluntary movement. Spontaneous defecation and penile erection were restored, and neuropathic pain was fully alleviated (the VAS score decreased from 8 to 0). Electrophysiological assessments revealed partial recovery of lower limb motor conduction and motor evoked potentials (MEPs), indicating possible corticospinal tract remodeling.Clinical relevance This single case provides preliminary clinical evidence that combined neuromodulation via central-peripheral-central strategy may be associated with functional recovery in complete SCI. Limitations of the single-case design and the lack of a control group are acknowledged, and the potential influence of spontaneous neurological recovery cannot be excluded. Further multicenter controlled trials are warranted to verify these findings.