Consequently, the anatomical integrity of these circuits is not compromised. Moreover, the vast majority of circuits involved in producing movements and regulating physiological functions are distant from the spinal cord damage. For unclear reasons, these anatomically intact neural projections remain functionally silent. However, most SCIs spare bridges of intact neural tissue that contain fibers still connected to executive centers located below the injury. An SCI scatters this exquisitely-organized communication system, which results in severe motor deficits and alters critical physiological functions. The brain broadcasts movement-related commands through parallel neuronal pathways that cascade from the cortex and brainstem to executive centers residing in the spinal cord (Arber and Costa 2018). Here, we summarize a series of preclinical and clinical advances in the development of neuromodulation therapies, brain-computer interfaces, and neurotechnology-supported neurorehabilitation programs that herald a new role of functional neurosurgeons in the restoration of neurological functions after SCI (Table 1).įull size table The era of restorative neurosurgery Until now, functional neurosurgeons are remotely involved in SCI medicine and their role remains confined to the management of spasticity or neuropathic pain with spinal cord stimulation. Due to the limited ability of the spinal cord for repair, many neurological deficits remain permanent, with devastating health consequences and substantial financial and social burdens for society. However, there is currently still no clinical trial that has reported robust efficacy of a spinal cord repair strategy for improving functional recovery after SCI. These surgical procedures, supportive measures, and rehabilitation programs have ameliorated neurological outcomes and decreased morbidity in patients with SCI (Fehlings et al. As soon as possible, the patient is transferred to a specialized SCI center where expert clinical teams deploy intensive rehabilitation programs and educate patients in the management of their bladder, bowel, and general body condition. The standards of good clinical practice for a traumatic SCI consist of stabilizing spine fractures, decompressing the spinal cord, and maintaining optimal hemodynamics to avoid hypotension and secondary spinal cord damage. We also discuss the new role of functional neurosurgeons in neurorestorative interventional medicine, a new discipline at the intersection of neurosurgery, neuro-engineering, and neurorehabilitation.Ī century of medical research and clinical practice has transformed the management of patients with spinal cord injury (SCI). Here, we summarize the impending arrival of bioelectronic medicine in the field of SCI. The spectrum of implantable brain-computer interface technologies is also expanding at a fast pace, and all these neurotechnologies are being progressively embedded within rehabilitation programs in order to augment plasticity of spared circuits and residual projections with training. Multiple neuromodulation therapies that target circuits located in the brain, midbrain, or spinal cord have been able to improve motor and autonomic functions. However, recent advances in bioelectronic medicine are changing this landscape. In the absence of approved treatments to repair damage to the central nervous system, the role of neurosurgeons after spinal cord injury (SCI) often remains confined to spinal cord decompression and vertebral fracture stabilization.
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