Neurorestorative interventions involving bioelectronic implants after spinal cord injury

Abstract

In the absence of approved treatments to repair damage to the central nervous system, the role of neurosurgeons after spinal cord injury (SCI) often remains confined to spinal cord decompression and vertebral fracture stabilization. However, recent advances in bioelectronic medicine are changing this landscape. Multiple neuromodulation therapies that target circuits located in the brain, midbrain, or spinal cord have been able to improve motor and autonomic functions. The spectrum of implantable brain-computer interface technologies is also expanding at a fast pace, and all these neurotechnologies are being progressively embedded within rehabilitation programs in order to augment plasticity of spared circuits and residual projections with training. Here, we summarize the impending arrival of bioelectronic medicine in the field of SCI. We also discuss the new role of functional neurosurgeons in neurorestorative interventional medicine, a new discipline at the intersection of neurosurgery, neuro-engineering, and neurorehabilitation.

Epidural Electrical Stimulation of the Lumbosacral Spinal Cord Improves Trunk Stability During Seated Reaching in Two Humans With Severe Thoracic Spinal Cord Injury

“…Over the last decade, transcutaneous spinal electrical stimulation and epidural spinal electrical stimulation (ES) have emerged as promising approaches that facilitate spinal sensorimotor circuits in a manner that produces a more physiological activation pattern compared to FES (Sayenko et al, 2014(Sayenko et al, , 2015Gerasimenko et al, 2008Gerasimenko et al, , 2015aMinassian et al, 2016a;Grahn et al, 2017;Hofstoetter et al, 2018). Additionally, in contrast to the use of FES as a neuroprosthetic technology, evidence suggests spinal stimulation engages spared sub-functional connections that span the injury site to restore volitional control over stimulation-enabled motor activity (Minassian et al, 2016b;Ievins and Moritz, 2017;Calvert et al, 2019a;Cho et al, 2019). For example, postural stability and ability to regain balance during self-initiated perturbations within a single session have been described through the use of transcutaneous spinal electrical stimulation in humans with motor complete (N = 6), as well as motor incomplete (N = 2), SCI (Rath et al, 2018); however, ES-enabled trunk stability and reaching ability while seated have not been described in detail.…”

Application of a neural interface for restoration of leg movements: Intra-spinal stimulation using the brain electrical activity in spinally injured rabbits

“…these treatments in humans (Lobel and Lee, 2014;Rezaee and Abdollahi, 2017). Indeed, to date, there has been no report of restoration of limb movement following SCI at spinal level using neural interface technologies by electrical stimulators, to create a bypass around the SCI site (Cho et al, 2019;Freund et al, 2011).…”

Imaging of Inflammation in Spinal Cord Injury: Novel Insights on the Usage of PFC-Based Contrast Agents

“…Since at present the only clinical treatments available for SCI, consisting of stabilization and decompression of spinal cord combined with a high dose of methylprednisolone, are still debated due to the limited beneficial effects, research for innovative therapies is still ongoing [ 7 ]. Besides implantable brain–computer interface technologies [ 8 ], cell therapy is one of the most promising approaches as the graft of stem cells has already provided valuable pre-clinical data about their regenerative potential in SCI animal models [ 4 , 9 , 10 ]. However, since the acute inflammatory process following the traumatic event is not favorable for survival and differentiation of transplanted cells, as well as the glial scar formation occurring at a later stage (subacute/intermediate phase) inhibits axonal regeneration, the successful outcome of cell therapies is strictly dependent on the timing of their administration [ 11 ].…”