1510 - Epidural Spinal Cord Stimulation and It's Role in Improving Autonomic Function in Spinal Cord Injury: A Review

Epidural spinal cord stimulation (eSCS) suggests multidomain autonomic benefit in chronic SCI. For cardiovascular dysregulation, two case series reported sustained MAP increases in hypotensive participants. eSCS prevented stimulus-evoked autonomic dysreflexia in some cases. Bowel outcomes improved in single cases and small series though one participant experienced worsened NBD scores despite shorter bowel regimen. Bladder function improved via higher voiding efficiency and increased bladder capacity sustained at follow-up. Sexual function and quality of life improved: reduced sexual distress and NBSS scores, higher IIEF-5 scores and ejaculation, and reduced NBSS symptoms. Adverse events were uncommon overall although one cohort reported infections (8%), washouts (12%), and one hip fracture. 

Conclusions:

Emerging evidence suggests that epidural spinal cord stimulation (eSCS) may enhance rehabilitation after spinal cord injury, with evidence in supporting improved blood-pressure regulation, voiding efficiency, and sexual function. Mechanistically, eSCS likely modulates spared spinal circuitry to strengthen supraspinal–spinal communication and support activity-dependent plasticity, especially when paired with targeted rehabilitation. However, the current literature is dominated by small, single-center studies with heterogeneous protocols, short follow-up, and limited controls, constraining generalizability. Safety appears acceptable, with mostly minor, manageable adverse events. To establish efficacy and durability, rigorously designed multicenter randomized trials using standardized stimulation paradigms, harmonized outcome measures, and extended follow-up are needed. Future work should also seek to refine candidate selection, optimize stimulation timing and dosing.