Epidural Spinal Cord Stimulation Facilitates Immediate Restoration of Dormant Motor and Autonomic Supraspinal Pathways after Chronic Neurologically Complete Spinal Cord Injury
Open accessAbstract
Epidural Spinal Cord Stimulation (eSCS) in combination with extensive rehabilitation has been reported to restore volitional movement in a select group of subjects after motor-complete spinal cord injury (SCI). Numerous questions about the generalizability of these findings to patients with longer term SCI have arisen, especially regarding the possibility of restoring autonomic function. To better understand the effect of eSCS on volitional movement and autonomic function, two female participants five and 10 years after injury at ages 48 and 52, respectively, with minimal spinal cord preservation on magnetic resonance imaging were implanted with an eSCS system at the vertebral T12 level. We demonstrated that eSCS can restore volitional movement immediately in two female participants in their fifth and sixth decade of life with motor and sensory-complete SCI, five and 10 years after sustaining severe radiographic injuries, and without prescribed or significant pre-habilitation. Both patients experienced significant improvements in surface electromyography power during a volitional control task with eSCS on. Cardiovascular function was also restored with eSCS in one participant with cardiovascular dysautonomia using specific eSCS settings during tilt challenge while not affecting function in a participant with normal cardiovascular function. Orgasm was achieved for the first time since injury in one participant with and immediately after eSCS. Bowel-bladder synergy improved in both participants while restoring volitional urination in one with eSCS. While numerous questions remain, the ability to restore some supraspinal control over motor function below the level of injury, cardiovascular function, sexual function, and bowel and bladder function should promote intense efforts to investigate and develop optimization strategies to maximize recovery in all participants with chronic SCI.
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The delivery of epidural electrical stimulation over the lumbar spinal cord has enabled many individuals with spinal cord injury to regain adaptive control over the activity of otherwise paralysed muscles.
“The delivery of epidural electrical stimulation over the lumbar spinal cord has enabled many individuals with spinal cord injury to regain adaptive control over the activity of otherwise paralysed muscles.”
From Walking naturally after spinal cord injury using a brain–spine interface (2023) · cites this paper as [34]
The Results (‘Volitional movements and muscle activity’; page not provided) report that epidural stimulation let both participants voluntarily activate some lower-extremity muscles. The claim overstates the evidence as applying to ‘many individuals’ and as restored adaptive control: the Introduction describes a limited number of prior reports, and the Discussion says the movements observed in this study were coarse and not functional. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThis recovery has been documented in various independent studies, including in participants with complete sensorimotor paralysis.
“This recovery has been documented in various independent studies, including in participants with complete sensorimotor paralysis5,6,30–34.”
From Walking naturally after spinal cord injury using a brain–spine interface (2023) · cites this paper as [34]
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Walking naturally after spinal cord injury using a brain–spine interface
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- Authors
- Darrow, D., Balser, D., Netoff, T. I., Krassioukov, A., Phillips, A., Parr, A., & Samadani, U.
- Affiliations
- University of Minnesota (US)
- Minneapolis VA Health Care System (US)
- University of British Columbia (CA)
- University of Calgary (CA)
- Hennepin County Medical Center (US)
- Corresponding author
- Darrow, David
- ORCID
- Venue
- Journal of Neurotrauma
- Publisher
- SAGE Publications
- Published
- 2019-07-12
- Volume
- 36
- Issue
- 15
- Pages
- 2325-2336
- ISSN
- 0897-7151 (ISSN-L)
- 1557-9042
- PMC
- PMC6648195
- OpenAlex
- W2913762349
- Cited by
- 254
- References
- 56
- Citations by year
- 2026: 24 · 2025: 35 · 2024: 42 · 2023: 43 · 2022: 34 · 2021: 37 · 2020: 25 · 2019: 13
- FWCI
- 20.06
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Neurotrauma (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spinal Cord Injury Research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Keywords
- epidural spinal cord stimulation, chronic spinal cord injury, motor complete spinal cord injury, cardiac autonomic dysfunction, voluntary movement, surface electromyography, sexual function, bowel and bladder function
- MeSH terms
- Chronic Disease, Efferent Pathways, Electromyography, Epidural Space, Female, Humans, Middle Aged, Spinal Cord Injuries, Thoracic Vertebrae, Autonomic Pathways, Tilt-Table Test, Recovery of Function, Implantable Neurostimulators, Spinal Cord Stimulation
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