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

Maxwell Boakye; Tyler Ball; Nicholas Dietz; Mayur Sharma; Claudia Angeli; Enrico Rejc; Steven Kirshblum; Gail Forrest; Forest W Arnold; Susan Harkema

doi:10.25259/SNI_1074_2022

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

Surg Neurol Int. 2023 Mar 17:14:87. doi: 10.25259/SNI_1074_2022. eCollection 2023.

Authors

Affiliations

¹ Department of Neurosurgery, University of Louisville, Louisville, Kentucky.
² Department of Neurosurgery, Vanderbilt University, Nashville.
³ Department of Physical Medicine Rehabilitation, Rutgers, Newark, New Jersey.
⁴ Department of Infectious Diseases, University of Louisville, Louisville, United States.

Abstract

Background: Traumatic spinal cord injury (tSCI) is a debilitating condition, leading to chronic morbidity and mortality. In recent peer-reviewed studies, spinal cord epidural stimulation (scES) enabled voluntary movement and return of over-ground walking in a small number of patients with motor complete SCI. Using the most extensive case series (n = 25) for chronic SCI, the present report describes our motor and cardiovascular and functional outcomes, surgical and training complication rates, quality of life (QOL) improvements, and patient satisfaction results after scES.

Methods: This prospective study occurred at the University of Louisville from 2009 to 2020. scES interventions began 2-3 weeks after surgical implantation of the scES device. Perioperative complications were recorded as well as long-term complications during training and device related events. QOL outcomes and patient satisfaction were evaluated using the impairment domains model and a global patient satisfaction scale, respectively.

Results: Twenty-five patients (80% male, mean age of 30.9 ± 9.4 years) with chronic motor complete tSCI underwent scES using an epidural paddle electrode and internal pulse generator. The interval from SCI to scES implantation was 5.9 ± 3.4 years. Two participants (8%) developed infections, and three additional patients required washouts (12%). All participants achieved voluntary movement after implantation. A total of 17 research participants (85%) reported that the procedure either met (n = 9) or exceeded (n = 8) their expectations, and 100% would undergo the operation again.

Conclusion: scES in this series was safe and achieved numerous benefits on motor and cardiovascular regulation and improved patient-reported QOL in multiple domains, with a high degree of patient satisfaction. The multiple previously unreported benefits beyond improvements in motor function render scES a promising option for improving QOL after motor complete SCI. Further studies may quantify these other benefits and clarify scES's role in SCI patients.

Keywords: Epidural stimulation; Functional recovery; Neuromodulation; Rehabilitation; Spinal cord injury; Spinal cord stimulation; Spinal surgery; Technical note.