Spinal cord neuromodulation for autonomic recovery following spinal cord injury: a scoping review.

No randomised controlled trials have been published. Most human studies are case series, case reports or cohort studies with small samples and only four controlled studies. Many studies combined spinal cord stimulation with activity-based rehabilitation, so the independent contribution of stimulation cannot be separated. Autonomic outcomes were often secondary or exploratory and measured inconsistently, often by subjective report rather than standardised measures. Confounding medications and inconsistent reporting of stimulation parameters and outcome measures make interpretation difficult. The review states 68 included studies but then reports 53 clinical and 18 animal studies, which does not add up. Few studies compared acute with chronic stimulation or followed outcomes after stimulation stopped. Mechanistic research is scarce.

The review was funded by the Canadian Institute for Health Research, Rick Hansen Foundation, Praxis Spinal Cord Institute, U.S. Department of Defense, International Spinal Research Trust, Wings for Life, and Wings for Life Spinal Cord Research Foundation, with startup funds from the Department of Physical Medicine and Rehabilitation, College of Medicine, University of Kentucky. No conflicts of interest are reported in the supplied text.

Do not conclude that spinal cord stimulation is an established treatment for autonomic problems after spinal cord injury. The review found no randomised trials, most human evidence comes from uncontrolled case series and cohort studies, and some participants had serious adverse effects such as sustained blood pressure spikes or urinary retention. The positive conclusion is based on low-certainty evidence.