This Nature article presents a breakthrough brain-spine interface (BSI) that restored natural walking ability in a 38-year-old male with chronic, incomplete cervical (C5/C6) spinal cord injury (SCI) sustained a decade prior. The BSI establishes a wireless "digital bridge" between cortical motor intentions and spinal cord circuits. It integrates two fully implanted systems: electrocorticography (ECoG) implants (WIMAGINE) over the sensorimotor cortex record neural signals, decoded in real-time (~100ms latency) by a portable unit to predict movement intentions (e.g., hip/knee/ankle flexion). These predictions are wirelessly transmitted to an implanted pulse generator (Medtronic ACTIVA RC) connected to a 16-electrode paddle lead epidurally positioned over lumbosacral dorsal root entry zones. The system modulates epidural electrical stimulation (EES) amplitude analogously to the decoded intention, enabling volitional control of lower limb muscles for standing and walking.

Calibrated rapidly (<5 mins) and stably over one year, including independent home use, the BSI allowed the participant to walk naturally with crutches, climb stairs, and traverse complex terrains. Crucially, neurorehabilitation using the BSI led to significant neurological recovery: even with the BSI off, he regained the ability to walk with crutches, evidenced by improved motor/sensory scores, WISCI II score increase (6 to 16), enhanced balance (Berg Scale), and gait metrics closer to healthy individuals. This recovery is attributed to BSI-facilitated reorganization of residual neuronal pathways. The study, part of the STIMO-BSI trial (NCT04632290), demonstrates a framework for restoring natural movement after paralysis, with potential applicability to broader SCI populations, though validation beyond this single case is needed. Future directions include device miniaturization and cervical application for upper limb restoration.