Aug 2026· Frontiers in Neurology· 0 citations· 32 references
TL;DR
Its role is comparatively well supported in selected chronic neuropathic pain populations, particularly chronic back and leg pain after spinal surgery and painful diabetic neuropathy, and applications in diabetic foot complications, spinal cord injury, and disorders of consciousness are supported mainly by small, heterogeneous, or uncontrolled studies.
Abstract
Invasive spinal cord stimulation (SCS) is used in selected patients with refractory chronic neuropathic pain and has also been explored in spinal cord injury, disorders of consciousness, and Parkinson’s disease. However, the strength of evidence differs substantially across indications. This review summarizes the current clinical applications of invasive SCS and distinguishes relatively established pain indications from emerging neurological applications.
We conducted a structured search of PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, Wanfang, and China National Knowledge Infrastructure. The search was supplemented by reference tracking for landmark studies and a targeted update of relevant publications from 2024 to 2026.
Randomized evidence is concentrated in chronic pain populations. Conventional SCS has shown benefit in selected patients with failed back surgery syndrome, while 10-kHz SCS produced greater pain reduction than conventional low-frequency stimulation in patients with chronic back and leg pain. Burst stimulation was noninferior to tonic stimulation in the SUNBURST trial and was preferred by most participants. Randomized evidence also supports 10-kHz SCS in refractory painful diabetic neuropathy. Evidence for complex regional pain syndrome suggests short- to intermediate-term pain relief, although long-term benefit remains uncertain. By contrast, applications in diabetic foot complications, spinal cord injury, and disorders of consciousness are supported mainly by small, heterogeneous, or uncontrolled studies. Recent blinded trials have not demonstrated a clear benefit of SCS for Parkinsonian gait impairment.
The clinical evidence supporting invasive SCS varies considerably across neurological indications. Its role is comparatively well supported in selected chronic neuropathic pain populations, particularly chronic back and leg pain after spinal surgery and painful diabetic neuropathy. Evidence for non-pain neurological disorders remains limited, and these applications should remain investigational until further controlled studies clarify patient selection, stimulation parameters, durability of response, and safety.
Future progress in SCS will likely depend on artificial intelligence, remote monitoring, biomarker-guided programming, and integration with multidisciplinary chronic pain care.
Nafay Abdul, Milan Patel, Rohit Aiyer et al.· Journal of Clinical Medicine· 0 citations
Spinal cord stimulation (SCS) is a form of neuromodulation that delivers electrical impulses to the spinal cord, altering pain signals to provide relief from chronic pain. Since its introduction in the 1960s, SCS has primarily targeted the dorsal columns of the spinal cord. While SCS has proven effective for many neuropathic pain conditions, its limitations have driven exploration of alternative anatomical targets for electrical stimulation. Work in the 1970's suggested that ventral column spinal cord stimulation (VC-SCS) might offer superior pain relief by targeting the spinothalamic tracts (Hoppenstein, 1975). Several decades later, a study reported successful use of VC-SCS for visceral pain in 26 patients (Baranidharan et al, 2014). A recent case report demonstrated comparable outcomes between dorsal and ventrolateral SCS for post-laminectomy syndrome (van Acker and Kim, 2023). Noordin et al (2023) reported meaningful improvements in pain and function using VC-SCS in a patient with chronic visceral pain. Finally, Sheen et al (2024) demonstrated pain relief for 12 months in a patient with VC-SCS. VC-SCS represents a promising investigational approach for pain syndromes refractory to traditional dorsal column stimulation. Ongoing research should focus on refining techniques and addressing critical knowledge gaps regarding patient selection and the durability of outcomes.
Behnum A. Habibi, Chong H. Kim, Gustaf M. Van Acker· American Journal of Physical...· 0 citations
BACKGROUND
Spinal cord injury (SCI) can lead to severe impairments in motor, sensory, and autonomic functions, significantly affecting patients' functional independence and quality of life. Transcutaneous spinal cord stimulation (tSCS), as an emerging non-invasive neuromodulation technique, has shown potential in improving motor function. However, existing studies demonstrate substantial heterogeneity, and its clinical efficacy remains unclear.
OBJECTIVE
To systematically evaluate the effects of tSCS on motor function and functional independence in individuals with SCI, and to explore the potential influence of patient characteristics and stimulation parameters on treatment outcomes.
METHODS
A systematic search of PubMed, Web of Science, Cochrane Library, Embase, and Scopus was conducted from database inception to March 23, 2026. Eligible studies included randomized controlled trials (RCTs), non-randomized studies, and case series. Methodological quality was assessed using the revised Cochrane Risk of Bias tool (RoB 2) for RCTs, the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool, and the Joanna Briggs Institute (JBI) critical appraisal checklist for case series. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence. This review was registered in PROSPERO (registration number: CRD420251106919).
RESULTS
A total of 25 studies (n = 353) were included, comprising 9 RCTs, 10 non-randomized studies, and 6 case series. Due to substantial heterogeneity in study design, patient characteristics, and intervention parameters, a qualitative synthesis was performed. The findings suggest that tSCS may have beneficial effects on upper limb motor function as well as balance and postural control. However, no consistent or stable improvements were observed in lower limb motor function, walking ability, functional independence, spasticity, or quality of life. According to the GRADE assessment, the overall certainty of evidence was very low. In terms of safety, tSCS was well tolerated, with no serious adverse events reported.
CONCLUSION
Current evidence is insufficient to support the definitive efficacy of tSCS in individuals with SCI. Although potential benefits have been observed in certain functional domains, the robustness of the evidence is limited by small sample sizes, methodological limitations, and substantial heterogeneity across studies. High-quality randomized controlled trials are needed to further establish its clinical effectiveness.
Jingjing Liu, Yinxu Wang, Xin Chen et al.· Journal of NeuroEngineering...· 0 citations
ABSTRACT Introduction Chronic migraine (CM) refractory to conventional pharmacotherapy (r-CM) remains a debilitating neurological condition with limited therapeutic options. High-frequency spinal cord stimulation at 10 kilohertz (HF-SCS) has recently emerged as a distinct neuromodulatory paradigm for this patient population. Unlike traditional spinal cord stimulation, HF-SCS operates above the frequency range that generates paresthesia, thereby eliminating stimulation-induced sensation while potentially engaging unique analgesic mechanisms. Areas covered This focused narrative review synthesizes the available clinical evidence, technical considerations, and mechanistic hypotheses specifically pertaining to cervical HF-SCS for refractory chronic migraine (r-CM). The authors further provide their expert perspectives on the future of this technology as a treatment option for refractory chronic migraine. Expert opinion Current data from prospective open-label studies and retrospective case series suggest that cervical HF-SCS may reduce monthly migraine days, facilitate conversion from chronic to episodic migraine patterns in some implanted patients, and may improve headache-related disability and quality of life over at least 52 weeks of follow-up. The paresthesia-free nature of HF-SCS confers a distinct advantage for both patient tolerability and future trial design, as it permits sham-controlled methodologies that have historically been impossible with conventional neurostimulation. However, these findings remain preliminary and should be considered hypothesis-generating pending confirmation in adequately powered randomized sham-controlled trials.
Paolo Martelletti, Claudio Tana· Expert Review of Neurotherap...· 0 citations
Background Burst deep brain stimulation (DBS) is a promising alternative to conventional deep brain stimulation (cDBS), incorporating paradigms such as theta burst stimulation (TBS), burst cycling (BC), and coordinated reset (CR). Findings from transcranial magnetic stimulation, spinal cord stimulation and focused ultrasound neuromodulation inspire its potential application in Parkinson's disease (PD). Objective This review evaluates the evidence on the efficacy and safety of burst DBS in PD. Methods A systematic literature search was conducted in PubMed, Embase, and Web of Science. Inclusion criteria encompassed peer-reviewed primary preclinical or clinical studies in English, reporting motor outcomes and burst stimulation parameters. Methodological quality was assessed using SYRCLE and a modified Newcastle-Ottawa Scale. Data extraction was performed systematically, and findings were synthesized narratively. Results 19 studies met inclusion criteria: nine preclinical and ten clinical studies. Eight focused on BC (three including safety), four examined TBS (two including safety), and seven addressed CR (one including safety). Burst DBS showed mostly similar acute efficacy to cDBS, with distinct post-stimulation effects. No major adverse events were reported. However, stimulation settings varied widely, with no consensus on optimal parameters. Conclusion Efficacy and safety of burst DBS appear to be comparable to cDBS, with potential benefits such as post-stimulation effects. However, the risk of bias, variability in stimulation settings, inconsistent terminology, and other methodological considerations limit the interpretation of previous research. Further randomized studies are crucial to better refine the stimulation parameters and establish standardized clinical protocols that can be used to compare burst DBS with cDBS.
Martijn Hendriks, Matej Lokar, H. Arnts et al.· Journal of Parkinson's Disea...· 0 citations
Spinal cord injuries (SCIs) profoundly impact millions globally, leading to loss of motor and sensory functions below the injury site. Brain-spine interfaces (BSIs) represent an early-stage neuroprosthetic strategy that attempts to restore functional communication between cortical motor-intention signals and spinal sensorimotor circuits below the level of injury. Although early preclinical and highly selected clinical studies have shown encouraging motor outcomes, the evidence remains preliminary, and routine clinical use is limited by questions regarding safety, durability, patient selection, accessibility, and long-term functional benefit. BSI approaches are based on the observation that residual spinal pathways and sensorimotor circuits may remain partially responsive to neuromodulation even after injury. Along the way, technological advancements have significantly bolstered SCI treatment strategies, ranging from surgical interventions to regenerative therapies. Approaches such as neurostimulation and biomaterial-based strategies have shown potential in experimental and early translational settings, although their clinical efficacy and generalizability remain incompletely established. Furthermore, exploring neuroplasticity and the body’s intrinsic ability to reorganize neural connections post-injury underscores the potential for spontaneous recovery in certain cases. However, integrating BSIs into clinical practice faces substantial hurdles, including technical challenges, ethical considerations, and the need for specialized training for healthcare providers. Despite these obstacles, BSIs and other novel treatments may have potential to improve the quality of life for SCI patients, although further clinical investigation is needed to establish their safety, efficacy, and generalizability. This review catalogs recent conceptual and technological developments contributing to the emergence of BSI.
Vijay Sivan, Zahin Alam, H. Polavarapu et al.· Neurosurgical review· 0 citations