After the introduction of MRI-compatible leads for sacral neuromodulation (SNM), the use of SNM for neurogenic bladder management has increased, despite its off-label status. Some reports indicate successful SNM trials in patients with incomplete spinal cord injury (SCI), but no documented cases exist for complete SCI. Here, we present the first successful SNM implantation in a patient with chronic (>2 years post-injury) complete SCI.

The patient was a 31-year-old male who sustained a complete SCI at T2-3 (ASIA-A) due to a motor vehicle accident in May 2022, resulting in spastic paraplegia, double incontinence, and erectile/ejaculatory dysfunction. He had a baclofen pump implanted for spasticity. Renal function tests and upper urinary tract imaging were normal. Video urodynamics revealed a small bladder (250 mL), neurogenic detrusor overactivity and impaired compliance but no urodynamic stress incontinence or vesicoureteral reflux . He was initially managed with self-catheterization and anticholinergics, followed by 300 IU of botulinum toxin A injections, which provided a good response.

Given the limited treatment options, shared decision-making led to an SNM trial despite the low expected success rate. The stage I procedure was uneventful, and the baclofen dose was reduced from 450 mcg to 200 mcg. A 6-week trial period was initiated, with daily bladder and bowel diaries.

Initial Programming:
Settings: Program +3, -1, 0
Amplitude: 0.7V (sensation in scrotum and penis)
Pulse Width (PW): 210 μsec
Pulse Rate (PR): 14 Hz
Outcome: No significant improvement in incontinence episodes, drained urine volume, or stool consistency.

Day 10, program was modified as follows:
Settings: Program +0, -2, 3 (sensation in anus and scrotum)
Amplitude: 0.6V (increased by 0.1V every other day)
PW: 300 μsec (unchanged)
PR: Initially 21 Hz, reduced to 18 Hz after 2 weeks

On Day 14: the patient had 50% reduction in urinary incontinence (UI) episodes; drained urine volume increased to 380–450 mL.
On Day 20: Softer stools and improved erectile function.

Week 5 (Amplitude was 2.6v):
UI improved by 60%.
Fecal incontinence improved by 40–50%
Erection improvement by 30% (amplitude: 2.6V)
The neuromodulator was implanted at week 6, and the patient maintained the response at 3-month follow-up.

Sacral neuromodulation (SNM) shows promising outcomes in some incomplete spinal cord injury (SCI) patients, with studies reporting improved bladder/bowel function in 45-75%, especially in patients with ASIA-C & ASIA-D, but no reported success in complete spinal cord injury (ASIA-A), especially those with chronic injury . This case gives hope that sacral neuromodulation may give good results in carefully selected patients with complete SCI.

Although chronic, complete SCI patients lose neuroplasticity, the mechanism of SNM efficacy in this patient remains unclear, but this case suggests potential benefits. Adjusting programming parameters (e.g., pulse rate and gradual voltage increments) may help elicit neuronal responses. Further studies are needed to explore SNM’s role in complete SCI patients.

Chen, G., Liao, L. Sacral neuromodulation for neurogenic bladder and bowel dysfunction with multiple symptoms secondary to spinal cord disease. Spinal Cord 53, 204–208 (2015).
Bauer, S.; Grassner, L.; Maier, D.; Aigner, L.; Lusuardi, L.; Peters, J.; Mach, O.; Roider, K.; Beyerer, E.; Kleindorfer, M.; et al. Early Sacral Neuromodulation: A Promising Opportunity or an Overload for Patients with a Recent Spinal Cord Injury? A Cross-Sectional Study. J. Clin. Med. 2025, 14, 1031.