Invasive Neuromodulation for Spinal Cord Injury

Spinal cord injury (SCI) results in chronic neurological impairment and confers a poor prognosis, most prominently affecting sensorimotor and autonomic nervous systems. In light of decades of research and clinical trials, there has been minimal progress towards advancing the treatment of individuals suffering from SCI. No FDA-approved therapeutics currently exist for SCI, and only intensive neurorehabilitation regimens have demonstrated a potential for improving neurological function post-SCI. Current SCI-related therapies are focused on managing SCI-related complications rather than attempting to directly restore function. Neurosurgical involvement is largely confined to spinal cord decompression and vertebral column stabilization. Invasive neuromodulation is an established treatment approach for neurological conditions including Parkinson’s disease. More recently, the clinical application of neuromodulation to restore locomotor and autonomic function in patients suffering from SCI has made significant progress. The spectrum of neuromodulation for SCI is diverse and rapidly evolving. Direct stimulation of the spinal cord has great promise to advance and augment rehabilitation. Here, we summarize the landscape of invasive neuromodulation for SCI, and what has been learned from prior and current studies and trials. We also discuss the future of neuromodulation techniques and approaches for SCI, applications, and patient considerations, and how to integrate functional neurosurgeons into this emerging paradigm.