Cardiovascular Effects of Spinal Cord Stimulation: The Highs, the Lows, and the Don't Knows

Marco Law; Rahul Sachdeva; David Darrow; Andrei Krassioukov

doi:10.1016/j.neurom.2023.07.010

Cardiovascular Effects of Spinal Cord Stimulation: The Highs, the Lows, and the Don't Knows

Neuromodulation. 2023 Sep 2:S1094-7159(23)00714-6. doi: 10.1016/j.neurom.2023.07.010. Online ahead of print.

Authors

Marco Law¹, Rahul Sachdeva², David Darrow³, Andrei Krassioukov⁴

Affiliations

¹ International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
² International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Electronic address: sachdeva@icord.org.
³ Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA; Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, MN, USA.
⁴ International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; G.F. Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.

PMID: 37665302
DOI: 10.1016/j.neurom.2023.07.010

Abstract

Background and objectives: There are many potential etiologies of impaired cardiovascular control, from chronic stress to neurodegenerative conditions or central nervous system lesions. Since 1959, spinal cord stimulation (SCS) has been reported to modulate blood pressure (BP), heart rate (HR), and HR variability (HRV), yet the specific stimulation sites and parameters to induce a targeted cardiovascular (CV) change for mitigating abnormal hemodynamics remain unclear. To investigate the ability and parameters of SCS to modulate the CV, we reviewed clinical studies using SCS with reported HR, BP, or HRV findings.

Materials and methods: A keyword-based electronic search was conducted through MEDLINE, Embase, and PubMed data bases, last searched on February 3, 2023. Inclusion criteria were studies with human participants receiving SCS with comparison with SCS turned off, with reporting of either HR, HRV, or BP findings. Non-English studies, conference abstracts, and studies not reporting standalone effects of SCS when comparing SCS with non-SCS interventions were excluded. Results were plotted for visual analysis. When available, participant-specific stimulation parameters and effects were extracted and quantitatively analyzed using ordinary least squares regression.

Results: A total of 59 studies were included in this review; 51 studies delivered SCS invasively through implanted/percutaneous leads. Eight studies used noninvasive, transcutaneous electrodes. We found numerous reports of cervical, high thoracic, and mid-to-low thoracolumbar SCS increasing resting BP, and cervical/mid-to-low thoracolumbar SCS decreasing BP. The effect of SCS location on HR and HRV was equivocal. We were unable to analyze stimulation parameters owing to inadequate parameter reporting in many publications.

Conclusions: Our findings suggest CV neuromodulation, particularly BP modulation, with SCS to be a promising frontier. Further research with larger randomized controlled trials and detailed reporting of SCS parameters will be necessary for appropriate evaluation of SCS as a CV therapy.

Keywords: Blood pressure; heart rate; heart rate variability; review; spinal cord stimulation.

Publication types

Review