Department of Neurological Surgery, University of Louisville.
Frazier Rehabilitation Institute, University of Louisville Health.
Curr Opin Neurol. 2022 Aug 1;35(4):536-543. doi: 10.1097/WCO.0000000000001080.
There is a long history of neuromodulation of the spinal cord after injury in humans with recent momentum of studies showing evidence for therapeutic potential. Nonrandomized, mechanistic, hypothesis-driven, small cohort, epidural stimulation proof of principle studies provide insight into the human spinal circuitry functionality and support the pathway toward clinical treatments.
Individuals living with spinal cord injury can recover motor, cardiovascular, and bladder function even years after injury using neuromodulation. Integration of continuous feedback from sensory information, task-specific training, and optimized excitability state of human spinal circuitry are critical spinal mechanisms. Neuromodulation activates previously undetectable residual supraspinal pathways to allow intentional (voluntary) control of motor movements. Further discovery unveiled the human spinal circuitry integrated regulatory control of motor and autonomic systems indicating the realistic potential of neuromodulation to improve the capacity incrementally, but significantly for recovery after severe spinal cord injury.
The discovery that both motor and autonomic function recovers with lumbosacral spinal cord placement of the electrode reveals exciting avenues for a synergistic overall improvement in function, health, and quality of life for those who have been living with the consequences of spinal cord injury even for decades.
目的综述：在人类中，脊髓损伤后的神经调节有着悠久的历史，近期的研究势头表明其具有治疗潜力。非随机、机制性、假设驱动、小队列、硬膜外刺激的原理证明研究为人类脊髓回路的功能提供了深入的了解，并为临床治疗铺平了道路。
最新发现：即使在脊髓损伤多年后，通过神经调节，脊髓损伤患者也可以恢复运动、心血管和膀胱功能。整合来自感觉信息的连续反馈、特定任务的训练以及优化人类脊髓回路的兴奋性状态是至关重要的脊髓机制。神经调节激活了以前无法检测到的残余的上位通路，从而允许对运动运动进行有意（自愿）控制。进一步的发现揭示了人类脊髓回路对运动和自主系统的综合调节控制，表明神经调节具有现实的潜力，可以逐步但显著地提高严重脊髓损伤后的恢复能力。
总结：电极放置在腰骶脊髓位置时，运动和自主功能都能恢复，这一发现为那些因脊髓损伤而生活了数十年的人提供了令人兴奋的途径，以实现功能、健康和生活质量的协同整体改善。
