Abstract
Study design
Systematic review.
Objectives
Over the past decade, an increasing number of studies have demonstrated that epidural spinal cord stimulation (SCS) can successfully assist with neurorehabilitation following spinal cord injury (SCI). This approach is quickly garnering the attention of clinicians. Therefore, the potential benefits of individuals undergoing epidural SCS therapy to regain sensorimotor and autonomic control, must be considered along with the lessons learned from other studies on the risks associated with implantable systems.
Methods
Systematic analysis of literature, as well as preclinical and clinical reports.
Results
The use of SCS for neuropathic pain management has revealed that epidural electrodes can lose their therapeutic effects over time and lead to complications, such as electrode migration, infection, foreign body reactions, and even SCI. Several authors have also described the formation of a mass composed of glia, collagen, and fibrosis around epidural electrodes. Clinically, this mass can cause myelopathy and spinal compression, and it is only treatable by surgically removing both the electrode and scar tissue.
Conclusions
In order to reduce the risk of encapsulation, many innovative efforts focus on technological improvements of electrode biocompatibility; however, they require time and resources to develop and confirm safety and efficiency. Alternatively, some studies have demonstrated similar outcomes of non-invasive, transcutaneous SCS following SCI to those seen with epidural SCS, without the complications associated with implanted electrodes. Thus, transcutaneous SCS can be proposed as a promising candidate for a safer and more accessible SCS modality for some individuals with SCI.
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Acknowledgements
GT is grateful to Dr. Elisa Ius for her excellent assistance in preparing the manuscript. The authors thank Dr. Gillian Hamilton and Rachel Markley for reviewing and proofreading the manuscript.
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GT was supported by the Leonardo da Vinci 2019 fellowship from The Conference of Italian University Rectors and the Ministry of Education, University and Research (Italy). DS received philanthropic funding from Paula and Rusty Walter and Walter Oil & Gas Corp. The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.
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GT conceptualized the review. GT, SB, PH, HCB, and DS screened potential studies. GT, SB, and DS performed the search. GT prepared the table. GT and DS interpreted results and drafted the manuscript. All authors revised the manuscript, and approved the final version. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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Taccola, G., Barber, S., Horner, P.J. et al. Complications of epidural spinal stimulation: lessons from the past and alternatives for the future. Spinal Cord 58, 1049–1059 (2020). https://doi.org/10.1038/s41393-020-0505-8
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DOI: https://doi.org/10.1038/s41393-020-0505-8
