Human Performance Laboratory, Department of Anatomy, School of Medicine, Trinity College Dublin, Dublin, Ireland.
John Stearne Medical Library, Trinity Centre for Health Sciences, School of Medicine, St. James's Hospital, Dublin, Ireland.
NeuroRehabilitation. 2021;49(1):1-22. doi: 10.3233/NRE-210093.
Epidural spinal cord stimulation (ESCS) emerged as a technology for eliciting motor function in the 1990's and was subsequently employed therapeutically in the population with spinal cord injury (SCI). Despite a considerable number of ESCS studies, a comprehensive systematic review of ESCS remains unpublished.
The current review of the existing literature evaluated the efficacy of ESCS for improving motor function in individuals with SCI.
A search for ESCS studies was performed using the following databases: Medline (Ovid), Web of Science and Embase. Furthermore, to maximize results, an inverse manual search of references cited by identified articles was also performed. Studies published between January 1995 and June 2020 were included. The search was constructed around the following key terms: Spinal cord stimulation, SCI and motor response generation.
A total of 3435 articles were initially screened, of which 18 met the inclusion criteria. The total sample comprised of 24 participants with SCI. All studies reported some measure of improvement in motor activity with ESCS, with 17 reporting altered EMG responses. Functional improvements were reported in stepping (n = 11) or muscle force (n = 4). Only 5 studies assessed ASIA scale pre- and post-intervention, documenting improved classification in 4 of 11 participants. Appraisal using the modified Downs and Black quality checklist determined that reviewed studies were of poor quality. Due to heterogeneity of outcome measures utilized in studies reviewed, a meta-analysis of data was not possible.
While the basic science is encouraging, the therapeutic efficacy of ESCS remains inconclusive.
硬膜外脊髓刺激 (ESCS) 作为一种诱发运动功能的技术出现于 20 世纪 90 年代，随后在脊髓损伤 (SCI) 人群中被用于治疗。尽管有相当数量的 ESCS 研究，但 ESCS 的综合系统评价仍未发表。
目前对现有文献的综述评估了 ESCS 改善 SCI 患者运动功能的疗效。
使用以下数据库对 ESCS 研究进行了检索：Medline（Ovid）、Web of Science 和 Embase。此外，为了最大限度地提高结果，还对已确定文章引用的参考文献进行了反向手动检索。纳入的研究发表时间为 1995 年 1 月至 2020 年 6 月。检索围绕以下关键词构建：脊髓刺激、SCI 和运动反应产生。
最初筛选出 3435 篇文章，其中 18 篇符合纳入标准。总样本包括 24 名 SCI 患者。所有研究均报告了 ESCS 可改善运动活动的某种程度，其中 17 项研究报告了改变的肌电图反应。在踏步（n=11）或肌肉力量（n=4）方面报告了功能改善。仅有 5 项研究评估了干预前后的 ASIA 量表，记录了 11 名参与者中有 4 名的分类得到改善。使用改良的 Downs 和 Black 质量清单进行评估，确定所审查的研究质量较差。由于所审查研究中使用的结果测量指标存在异质性，因此无法对数据进行荟萃分析。
尽管基础科学令人鼓舞，但 ESCS 的治疗效果仍不确定。
