{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T13:06:57Z","timestamp":1789391217427,"version":"build-2803163510"},"reference-count":35,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Epidural electrical stimulation (EES) is an investigational, off-label neuromodulation strategy used adjunctively with rehabilitation in chronic spinal cord injury (SCI), but safety and longitudinal functional data specific to traumatic cervical SCI remain limited. This is a descriptive safety-and-feasibility study, not an efficacy study; no efficacy or causal claim is made. Methods: In this single-centre observational cohort, 32 consecutive patients with traumatic cervical SCI underwent EES implantation and were included in baseline and safety analyses, while longitudinal analyses comprised the 26 participants with complete Spinal Cord Independence Measure (SCIM) III data at baseline and 3, 6, 9 and 12 months. Rehabilitation dose was quantified (approximately 1087 prescribed therapy hours over 12 months) and adverse events were classified using ISO 14155:2020 definitions with WHO\u2013UMC causality grading. Prespecified outcomes were device- and procedure-related adverse events and total and domain-specific SCIM III scores; analyses were descriptive. Results: Patients were aged 33.8 \u00b1 10.3 years, 28 (87.5%) were male, and baseline AIS grade was A in 31 and B in 1. Mean total SCIM III increased from 14.81 \u00b1 8.92 at baseline to 21.77 \u00b1 14.60, 25.12 \u00b1 15.90, 28.23 \u00b1 17.68 and 32.42 \u00b1 19.45 at 3, 6, 9 and 12 months (all p &lt; 0.001), with gains across self-care, respiration and sphincter management, and mobility; 10 of 32 patients (31.3%) improved by at least one AIS grade. Adverse events were infrequent: sterile hardware-site inflammation (2, 6.3%), explantation (1, 3.1%) and a first-ever seizure (1, 3.1%), without stimulation-related neurological deterioration. Conclusions: The cohort was highly selected (31\/32 baseline AIS A; 87.5% male; injury-to-implant interval 10\u2013339 months), no comparator group was available, stimulation programming was individualised rather than protocolised, and 6 of 32 patients lacked complete 12-month follow-up; these features limit reproducibility and generalisability and preclude any inference about effectiveness. EES with rehabilitation was well tolerated and accompanied by progressive functional gains, although the uncontrolled design precludes causal inference. The contribution of this report is therefore transparent safety, dose and programming data, together with a prespecified protocol framework intended to make a controlled, propensity-matched evaluation of EES in traumatic cervical SCI feasible and reproducible.<\/jats:p>","DOI":"10.3390\/jcm15187114","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:09:51Z","timestamp":1789387791000},"page":"7114","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Epidural Electrical Stimulation Within an Integrated Rehabilitation Pathway for Traumatic Cervical Spinal Cord Injury: Safety and 12-Month Functional Outcomes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4232-3217","authenticated-orcid":false,"given":"Arzu Dinc","family":"Yavas","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, School of Medicine, Istanbul Ayd\u0131n University, 34295 Istanbul, T\u00fcrkiye"},{"name":"Graduate Education Stem Cell and Tissue Engineering, Istinye University, 34396 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6103-0527","authenticated-orcid":false,"given":"Aslihan Cevik","family":"Baran","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, School of Medicine, Istanbul Ayd\u0131n University, 34295 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emir","family":"Eker","sequence":"additional","affiliation":[{"name":"Dr. Asl\u0131han Cevik\u2019s Clinic, 34340 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyma","family":"Sarioglu","sequence":"additional","affiliation":[{"name":"Dr. Asl\u0131han Cevik\u2019s Clinic, 34340 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0253-9950","authenticated-orcid":false,"given":"Luay","family":"Serifoglu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u00dcmraniye Research and Education Hospital, 34766 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edip","family":"Gonullu","sequence":"additional","affiliation":[{"name":"Department of Algology, School of Medicine, Bak\u0131r\u00e7ay University, 35665 \u0130zmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ece","family":"Balkuv","sequence":"additional","affiliation":[{"name":"Department of Neurology, \u00dcsk\u00fcdar State Hospital, 34660 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serif","family":"Onen","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, School of Medicine, Atlas University, 34408 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gorkem","family":"Acar","sequence":"additional","affiliation":[{"name":"Faculty of Sports Science, Istanbul Gelisim University, 34310 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1046-2829","authenticated-orcid":false,"given":"Georgios","family":"Matis","sequence":"additional","affiliation":[{"name":"Interventional Pain Management, Spasticity and Neuromodulation Unit, Hygeia Hospital, 15123 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Kilic","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medicana Zincirlikuyu Hospital, 34394 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130brahim","family":"Asik","sequence":"additional","affiliation":[{"name":"Division of Algology, Department of Anesthesiology and Reanimation, Faculty of Medicine, Ankara University, 06290 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ak\u0131n","family":"Akakin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, \u00dcsk\u00fcdar University, 34768 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilek","family":"Akakin","sequence":"additional","affiliation":[{"name":"Department of Histology and Embryology, School of Medicine, Marmara University, 34854 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6924-4105","authenticated-orcid":false,"given":"Yakup","family":"Ozsezer","sequence":"additional","affiliation":[{"name":"NEUROBIO Engineering, 34750 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halil","family":"Ulutabanca","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, Erciyes University, 38039 Kayseri, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sevil","family":"Karagul","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, \u0130stanbul Kent University, 34406 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0032-5393","authenticated-orcid":false,"given":"Shikhali","family":"Isgandarli","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Central Hospital Kozyata\u011f\u0131, 34742 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.46292\/sci2702-1","article-title":"International Standards for Neurological Classification of Spinal Cord Injury: Revised 2019","volume":"27","author":"Rupp","year":"2021","journal-title":"Top. 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