Expanding Indications for Epidural Spinal Cord Stimulation in Spinal Cord Injury

Background/Objectives: Epidural spinal cord stimulation (ESCS) has long been used to treat chronic neuropathic pain, but a growing body of evidence supports its use as a neuromodulatory intervention for spinal cord injury (SCI) itself, targeting motor, autonomic, bladder, bowel, and respiratory deficits rather than pain. Landmark studies show that lumbosacral and cervical ESCS, combined with activity-based rehabilitation, can enable volitional movement, standing, and stepping after chronic, motor-complete SCI, with gains persisting after stimulation is switched off in a subset of participants. For cardiovascular indications, recent head-to-head evidence indicates that the last three thoracic spinal cord segments, rather than the lumbosacral cord used in earlier studies, are the optimal stimulation target for safe, effective blood pressure regulation.

Methods

Narrative Review.