Who Can Get Epidural Stimulation?

Epidural stimulation is a medical intervention that has shown effective results in restoring function and improving quality of life for individuals with spinal cord injuries. However, this innovative procedure is not suitable for every patient. Careful patient selection is critical for achieving the best results.

What is epidural stimulation?

Before we move on to patient selection, it is important to understand what epidural stimulation is. In this procedure, a device is placed near the spinal cord and electrical impulses are sent. These impulses can reactivate dormant nerve pathways, allowing some degree of function to be restored to the area below the injury. While there is no definitive cure for spinal cord injuries, it can help patients regain movement, improve autonomic functions, and reduce chronic pain.

Who is epidural stimulation suitable for?

The technique is primarily designed for individuals with spinal cord injuries, but not all of these patients are ideal candidates. A patient’s suitability depends on the following factors:

  1. Type of Spinal Cord Injury

  • Partial: Patients with partial spinal cord injuries, where some nerve pathways remain intact, are generally more suitable candidates. These individuals have a higher potential for recovery because their spinal cords can still transmit some signals.
  • Complete: The technique appears to work for some patients with complete injuries, but results are more variable. Research is ongoing to determine its effectiveness for this group.

  1. Level of Injury

  • Thoracic and Lumbar Injuries: The technique is most commonly used for injuries at the thoracic (middle of the back) or lumbar (lower back) levels. These injuries often cause paraplegia (lower body paralysis), and treatment can help restore lower limb function.
  • Cervical Injuries: Patients with cervical (neck) injuries may also benefit from the procedure, but the procedure is more complex and carries a higher risk of complications.

  1. Motor and Functional Potential

Candidates should have some preserved nerve connections below the injury site to maximize stimulation effectiveness. Muscle atrophy should not be severe, and patients should have adequate muscle response potential.

  1. Time Since Injury

  • Chronic Spinal Cord Injury: Most studies and clinical trials have focused on individuals with chronic spinal cord injury (more than a year since injury). Because these patients are past the acute recovery phase, it is easier to assess the potential benefits of epidural stimulation.
  • Acute Spinal Cord Injury: The technique is still being investigated for use shortly after injury. Early intervention may have potential, but more research is needed.

  1. General Health and Medical History

  • Stable Health Values: Candidates should be in stable health with no significant medical conditions that would complicate surgery or recovery.
  • No Contraindications: In severe osteoporosis, active infections, etc., it may be preferable not to administer the treatment because of the harm it will cause to the patient.

  1. Realistic Expectations

  • Adherence to Rehabilitation: Epidural stimulation is not a stand-alone treatment. Patients must commit to intensive physical therapy and rehabilitation to maximize benefits.
  • Psychological Preparation: Candidates must have a positive mindset and realistic expectations about the results of the procedure.

What are the stages of the Patient Selection Process?

The patient selection process for the technique is conducted by a multidisciplinary team consisting of neurologists, neurosurgeons, physiotherapists, and psychologists. The basic steps in selection are:
  1. Comprehensive Assessment: The patient’s medical history, level of injury, and current functional abilities are thoroughly evaluated
  2. Diagnostic Imaging: MRI or CT scans are performed to assess the extent of spinal cord injury and identify structural abnormalities.
  3. Functional Testing: Tests are performed to assess remaining motor and sensory function in the area below the injury.
  4. Psychological Assessment: The patient’s mental health and readiness for the procedure and rehabilitation are assessed.

Sources:

  • National Institute of Neurological Disorders and Stroke (NINDS)
  • Mayo Clinic
  • Christopher & Dana Reeve Foundation
  • PubMed
  • Spinal Cord Injury Research Evidence (SCIRE)
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