Spinal cord epidural stimulation for motor and autonomic function recovery after chronic spinal cord injury: A case series and technical note

Surgical Neurology International, 2023 · DOI: 10.25259/SNI_1074_2022 · Published: March 17, 2023

Spinal Cord Injury Participation Neurology

Simple Explanation

This study investigates the use of spinal cord epidural stimulation (scES) to improve motor and autonomic function in patients with chronic spinal cord injury (SCI). It examines outcomes, complications, and patient satisfaction following scES implantation. The research involved implanting an epidural paddle electrode and internal pulse generator (IPG) in 25 patients with chronic motor complete SCI. After surgery, participants underwent training protocols involving voluntary movement, standing, stepping, and blood pressure stabilization with scES. The study found that scES was safe and achieved numerous benefits, including voluntary movement, cardiovascular regulation, and improved patient-reported QOL. Most patients were satisfied with the procedure and would undergo it again.

Study Duration

2009 to 2020

Participants

25 patients with chronic motor complete tSCI

Evidence Level

Level IV, Case Series

Key Findings

1
All participants achieved voluntary movement in the lower extremities after scES implantation.
2
A significant majority of participants (85%) reported that the procedure either met or exceeded their expectations, and 100% would undergo the operation again.
3
Beyond motor improvements, scES was associated with improvements in cardiovascular regulation, thermoregulation, respiratory function, cognition, bowel and bladder function, and sexual function.

Research Summary

This study presents a case series of 25 patients with chronic motor complete tSCI who underwent spinal cord epidural stimulation (scES). The study evaluated motor and cardiovascular outcomes, complication rates, QOL improvements, and patient satisfaction. The results indicate that scES is safe and effective in achieving voluntary movement and cardiovascular regulation. Patients also reported significant improvements in various aspects of their QOL, with a high degree of satisfaction with the procedure. The authors conclude that scES is a promising option for improving QOL after motor complete SCI, with benefits extending beyond improvements in motor function. They recommend further studies to quantify these additional benefits and clarify scES's role in SCI patients.

Practical Implications

Clinical Practice

scES can be considered as a therapeutic option for patients with chronic motor complete SCI to improve motor function, cardiovascular regulation, and overall QOL.

Future Research

Further research is needed to quantify the additional benefits of scES, such as improvements in bowel motility, systemic inflammation, metabolic syndromes, bone density, cognitive and mental health, immune health, infection frequency, and overall cost-effectiveness.

Surgical Technique

The study provides insights into surgical techniques, including optimal electrode placement and infection prevention protocols, which can inform and improve future scES implantation procedures.

Study Limitations

1
The sample size is relatively small, and additional multicenter studies are needed.
2
The follow-up duration was variable among participants.
3
Several other benefits remain to be quantified, including but not limited to benefits on bowel motility, systemic inflammation, metabolic syndromes, bone density, cognitive and mental health, immune health, infection frequency, and overall cost-effectiveness.

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