Expanding Indications for Epidural Spinal Cord Stimulation in Spinal Cord Injury
- 1Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA 02115, USA
Abstract
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. Results: This review summarizes the mechanistic rationale for ESCS in SCI, synthesizes recent (2022–2026) clinical and safety data across motor, cardiovascular, and bladder/bowel domains, catalogs the current international landscape of ongoing clinical trials grouped by level of evidence, and reports perspectives from the SCI patient community and treating clinicians on the priorities, barriers, and ethical considerations that will shape clinical translation. We also briefly contextualize ESCS for SCI within two non-SCI applications most mechanistically and translationally proximate to this literature—post-stroke upper-limb hemiparesis and cardiac autonomic modulation. Conclusions: We conclude with a discussion of methodological and translational barriers—small sample sizes, limited blinding, procedural risk, and variable responder profiles—that must be addressed before ESCS for SCI can move from investigational feasibility studies toward standard-of-care therapy.
Related
- Real-world device survival, revision burden and observed pain patterns after epidural spinal cord stimulation for neuropathic pain in adults with spinal cord injury: protocol for a longitudinal observational cohort study using routine clinical data
- Effect of epidural spinal cord stimulation combined with personalized neurorehabilitation in chronic motor-complete spinal cord injury: study protocol for the phase II single-arm feasibility RESTORES (RESToration Of Rehabilitative function with Epidural spinal Stimulation) trial
- Stimulation parameters of epidural spinal cord stimulation for functional recovery after spinal cord injury: a narrative review
- Cervical epidural spinal cord stimulation is associated with enhanced voluntary upper-limb muscle activation in chronic post-stroke hemiparesis: a pilot feasibility study
- Optimizing motor functions in incomplete spinal cord injury with simultaneous application of transcranial direct current stimulation and virtual reality assisted treadmill training: a study protocol for a randomized controlled trial {1a}
BibTeX
@article{gadot2026expanding,
title = {{Expanding Indications for Epidural Spinal Cord Stimulation in Spinal Cord Injury}},
author = {Ron Gadot and Yi Lu},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207936},
url = {https://www.mdpi.com/2077-0383/15/20/7936},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Expanding Indications for Epidural Spinal Cord Stimulation in Spinal Cord Injury
AU - Ron Gadot
AU - Yi Lu
PY - 2026
DA - 2026/10/14
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207936
UR - https://www.mdpi.com/2077-0383/15/20/7936
AB - 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. Results: This review summarizes the mechanistic rationale for ESCS in SCI, synthesizes recent (2022–2026) clinical and safety data across motor, cardiovascular, and bladder/bowel domains, catalogs the current international landscape of ongoing clinical trials grouped by level of evidence, and reports perspectives from the SCI patient community and treating clinicians on the priorities, barriers, and ethical considerations that will shape clinical translation. We also briefly contextualize ESCS for SCI within two non-SCI applications most mechanistically and translationally proximate to this literature—post-stroke upper-limb hemiparesis and cardiac autonomic modulation. Conclusions: We conclude with a discussion of methodological and translational barriers—small sample sizes, limited blinding, procedural risk, and variable responder profiles—that must be addressed before ESCS for SCI can move from investigational feasibility studies toward standard-of-care therapy.
SN - 2077-0383
ER -