20 Sep Can a Spinal Cord Stimulator Treat Spinal Cord Injury?
At Rocky Mountain Brain & Spine Institute, we have previously blogged about Spinal Cord Stimulation. This is a chronic pain treatment strategy since the 1960’s, and with advancements in technique is a reasonable option for certain patients. In its current use, spinal cord stimulation in the lower thoracic region treats only pain symptoms, and not weakness or numbness.
In a recent New England Journal of Medicine article1, the use of spinal cord stimulation for spinal cord injury is a new and promising application.
Severe spinal cord injury, leading to significant and potentially complete weakness and numbness, is extremely debilitating for patients. Standing and walking are highly desired goals. The spinal cord, like the brain, is part of our central nervous system, which essentially cannot repair itself following injury. This is different from our peripheral nervous system, comprising the nerves after they leave the spinal cord, which has the potential to regenerate following injury.
Much of the current research for spinal cord injury focuses on stem cells. While there has been promise in animal studies, human use seems to be limited in how to deliver the stem cells safely and then direct the stem cells to the desired nerve cell. Stem cells have not yet been successful in humans.
In this newest New England Journal of Medicine article1, four patients with traumatic spinal cord injury were treated with spinal cord stimulation. None of them were able to stand, walk or move their legs. Two of them had some retained sensory function. A spinal cord stimulator was placed in the lumbar spine, below where they injured their spine. After an intense therapy regimen over multiple months, two of the 4 patients reportedly were able to walk with assistive devices. These two patients were the ones that had retained some sensory function. The other two patients, who had lost all sensory function from their injury, reportedly gained some movement, were able to stand, but were unable to independently walk. None of the patients could move with the stimulator turned off. The exact mechanism of how these stimulators helped the injured spinal cord even work a little bit is unknown.
This research serves as hope for spinal cord injury patients to regain some movement and possibly walk with assistive devices. Again, this is purely investigational at this point. The stimulator is placed in the lumbar spine, as opposed to the traditional thoracic spine, and has achieved results only 50% of the time in a small sample of patients. We do not offer this treatment currently at Rocky Mountain Brain & Spine institute, but are excited about future research which may allow us to offer it to patients.
1) Angeli et al. Recovery of Over-Ground Walking after Chronic Motor Complete Spinal Cord Injury. New England Journal of Medicine. 379; 13, 1244-1250, 2018.