Everything to Know about Epidural Stimulation for Spinal Cord Injury
Epidural Stimulation for spinal cord injury (SCI), also known as epidural electrical stimulation (EES) and epi-stim, is something that has been slowly gaining popularity and interest in recent years with SCI survivors and researchers alike. This form of rehabilitative training uses electrical currents on the lower spinal cord to stimulate the nerves directly by bypassing the traditional brain-to-spinal-cord pathways. It is a form of functional electrical stimulation (FES), albeit FES is an above-the-skin approach that uses electrodes on top of the skin to aim voltage at the muscles below it.
Although there has been an increasing number of EES and FES studies on animals, human-based studies have been slower to take hold.
What Epidural Electrical Stimulation is and How It Works
The way that epidural stimulation for spinal cord injury works is that an epidural electrical stimulating electrode is implanted into the epidural space that is by the backside of the bones of your vertebral spine. This means that the electrode array is inserted in the gap space on top of the dura just outside of the spinal cord.
Although the use of electrical current in treating medical conditions has been traced back thousands of years, some of the first spinal cord stimulation (SCS) dates back about 50 years. According to an article from the American Academy of Pain Medicine’s journal Pain Medicine:
“Since the initial use of SCS by Shealy, the devices have changed from bipolar leads with an external power source to multi-contact leads with rechargeable generators. The technique involved with the placement of these implants requires the placement of a programmable lead into the epidural space by either a percutaneous needle approach or an open surgical approach.”
The electrode is used to send electrical currents to cause muscle contractions, which helps to move the targeted groups of muscles. In most cases after a spinal cord injury, the neurons and axons throughout the body are still in good condition. However, the brain cannot transmit signals to and from them because of the damage to the spinal cord. The implant device, through spinal cord stimulator surgery, helps to reactivate and use remaining intact neural networks within the spinal cord to direct the movements required to stand and take steps.
How Epidural Stimulation Can Help Spinal Cord Injuries
While epidural stimulation for spinal cord injury is not a “cure” for spinal cord injuries — because, at this time, no such cure exists — it is, however, a step forward in the evolution of understanding of what a spinal cord injury and related treatments entail. This is the case not only for researchers and people within the SCI community but the general public as well. As public awareness increases about the progress that has been made in this area of research, it can help grow the financial support needed to fund these studies and lead to new discoveries in the frontier of spinal cord injury research and treatments.
Why Pursue Epidural Stimulation as Part of SCI Treatment
Epidural electrical stimulation, particularly FES, shows great promise in helping some patients regain some abilities. Some patients who have undergone FES therapy have shown improvements in hand function, bladder and bowel control, improved core control, and even the ability to breathe without the use of a ventilator.
Complications of Epidural Stimulation for Spinal Cord Injury
While epidural stimulation shows incredible promise for people with spinal cord injuries, as with many types of procedures, there are potential risks. Many of the complications concern the implantation of the devices and their long-term use. However, the risks are shown to be significantly less than those of undergoing repeat back surgery, and the procedure may be more effective and cost-effective than chronic pain therapies (based on patient satisfaction), according to the Pain Medicine article.
The article also states that some of the complications of implanting an SCS system include:
- Nerve injury
- Epidural Fibrosis
- Epidural abscess
- Postdural puncture headache
- Pain at generator
- Wound infection
- Unacceptable programming
- Lead migration
- Current leak
- Generator failure
Some of these rare incidents of neurologic injury are “secondary to dural puncture, infection, cord contusion, actual needle penetration of the spinal cord, and epidural hematoma.”
Costs of Spinal Cord Stimulation in North America
According to Cost Helper Health, typical out-of-pocket costs of spinal cord stimulation for uninsured patients range between $15,000 and $50,000 (although they have been known to cost more): “According to a study funded by the Washington State Department of Labor and Industries, average total medical costs of implanting a SCS system range from $19,246 - $47,190 per patient.”
According to another study, the costs of electrical stimulation for spinal cord injury in the form of spinal cord stimulation between 1995 and 2006 was tens of thousands of dollars in both the United States and Canada:
“The cost of implanting a SCS system in Canada is $21,595 (CAD), in US Medicare $32,882 (USD), and in US Blue Cross Blue Shield (BCBS) $57,896 (USD). The annual maintenance cost of an uncomplicated case in Canada is $3539 (CAD), in US Medicare $5071 (USD), and in BCBS $7277 (USD). The mean cost of a complication was $5191 in Canada (range $136–18,837 [CAD]). In comparison, in the US the figures were $9649 (range $381–28,495) for Medicare and $21,390 (range $573–54,547) for BCBS (both USD). “
Spinal cord injuries present many physical, emotional, health, and mental challenges for SCI survivors and their loved ones. However, it’s important to remember that you are not alone throughout this process and that there is a large community of people in the U.S. who are facing similar circumstances.
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