Current barriers and ethical considerations for clinical implementation of epidural stimulation for functional improvement after spinal cord injury

Epidural stimulators, already FDA-approved for chronic pain, are being explored for functional improvements after spinal cord injury (SCI). Studies show potential for dramatic functional improvements following chronic SCI, such as restored volitional standing and walking. The study aimed to identify barriers to the clinical implementation of epidural stimulation for SCI, focusing on physician views. The goal was to stimulate discussion on how to utilize this technology responsibly. The ethical construct of equipoise is helpful when considering the balance between caution and providing potentially beneficial therapy. Equipoise exists when there is genuine uncertainty in the medical community concerning whether the intervention being tested is better than the standard of care.

• 1
  A significant majority of surveyed physicians (61.9%) reported being asked by patients about epidural stimulation for functional improvement.
• 2
  The study identified several barriers to clinical implementation, including the need for additional efficacy studies (92.9%), lack of clear guidelines on stimulation parameters (83.3%), and inability to identify which patients will benefit (76.2%).
• 3
  Most physicians believed epidural stimulator implants were somewhat or quite safe for individuals with SCI; however, 31.7% were unsure or felt it depended on the patient.