Tator Charles H, Minassian Karen, Mushahwar Vivian K
Division of Genetics & Development, University of Toronto, Toronto, Canada.
Handb Clin Neurol. 2012;109:283-96. doi: 10.1016/B978-0-444-52137-8.00018-8.
Spinal cord injury (SCI) is a devastating neurological condition that leads to loss of motor and sensory function. It commonly causes impairments in limb movements, respiration, bowel and bladder function, as well as secondary complications including pain, spasticity, and pressure ulcers. Numerous interventions such as neuroprotection, regeneration, pharmacology, rehabilitation training, and functional electrical stimulation are under investigation for improving function after SCI. This chapter discusses the use of spinal cord stimulation (epidural and intraspinal electrical stimulation) for alleviating pain and spasticity, and restoring standing and walking. Epidural stimulation is effective in reducing the intensity of intractable pain, but its effectiveness in the treatment of spasticity remains unclear. It can induce rhythmic, locomotor-like movements in the legs, presumably due to the activation of afferent pathways. Intraspinal microstimulation is a new electrical stimulation approach that activates locomotor-related networks within the ventral regions of the lumbosacral spinal cord. In animals, this approach is capable of producing prolonged, fatigue-resistant standing and stepping of the hindlegs. While the results in animals have been very encouraging, technical advancements are necessary prior to its implementation in humans with SCI. Taken collectively, spinal cord stimulation holds substantial promise in restoring function after neural injury or disease.
脊髓损伤（SCI）是一种严重的神经系统疾病，会导致运动和感觉功能丧失。它通常会引起肢体运动、呼吸、肠道和膀胱功能障碍，以及包括疼痛、痉挛和压疮在内的继发性并发症。目前正在研究多种干预措施，如神经保护、再生、药理学、康复训练和功能性电刺激，以改善脊髓损伤后的功能。本章讨论了脊髓刺激（硬膜外和脊髓内电刺激）在减轻疼痛和痉挛以及恢复站立和行走方面的应用。硬膜外刺激在减轻顽固性疼痛强度方面有效，但其在治疗痉挛方面的有效性仍不明确。它可以诱发腿部有节奏的、类似运动的动作，这可能是由于传入通路的激活。脊髓内微刺激是一种新的电刺激方法，可激活腰骶部脊髓腹侧区域内与运动相关的网络。在动物实验中，这种方法能够使后肢产生长时间、抗疲劳的站立和迈步动作。虽然动物实验的结果非常令人鼓舞，但在将其应用于脊髓损伤患者之前，还需要技术上的进步。总体而言，脊髓刺激在恢复神经损伤或疾病后的功能方面具有巨大潜力。
