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The safety of epidural spinal cord stimulation to restore function after spinal cord injury: post-surgical complications and incidence of cardiovascular events


Study design

Cohort prospective study.


Epidural spinal cord stimulation (eSCS) improves volitional motor and autonomic function after spinal cord injury (SCI). While eSCS has an established history of safety for chronic pain, it remains unclear if eSCS in the SCI population presents the same risk profile. We aimed to assess safety and autonomic monitoring data for the first 14 participants in the E-STAND trial.


Hennepin County Medical Center, Minneapolis and Minneapolis Veterans Affairs Medical Center, Minnesota, USA.


Monthly follow-up visits assessed surgical and medical device-related safety outcomes as well as stimulation usage. Beat-by-beat blood pressure (BP) and continuous electrocardiogram data were collected during head-up tilt-table testing with and without eSCS.


All participants had a motor-complete SCI. Mean (SD) age and time since injury were 38 (10) and 7 (5) years, respectively. There were no surgical complications but one device malfunction 4 months post implantation. Stimulation was applied for up to 23 h/day, across a broad range of parameters: frequency (18–700 Hz), pulse width (100–600 µs), and amplitude (0.4–17 mA), with no adverse events reported. Tilt-table testing with eSCS demonstrated no significant increases in the incidence of elevated systolic BP or a greater frequency of arrhythmias.


eSCS to restore autonomic and volitional motor function following SCI has a similar safety profile as when used to treat chronic pain, despite the prevalence of significant comorbidities and the wide variety of stimulation parameters tested.

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Fig. 1: The above vignette is a representative trace showing cardiovascular responses (SBP and DBP and HR) for an autonomic study participant (participant 10) during a standard autonomic assessment.
Fig. 2: Summary of SBP data.
Fig. 3: HR and arrhythmia analysis in response to eSCS.
Fig. 4: Daily and cumulative stimulation delivered at home during study enrollment.
Fig. 5: Stimulation parameter space exploration and energy delivered for participant 10 during follow-up month 2–7.

Data availability

Data will be made available upon reasonable request.


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We would like to thank the Minnesota Office of Higher Education SCI/TBI Grant Program for the funding to carry out this study and St. Jude/Abbott for a generous device donation. We would like to acknowledge the E-STAND study group in both Minnesota and Canada for carrying out study procedures. The authors would like to thank the participants of this study and study coordinators who were crucial for the success of the present study.


This study is funded by a MN State SCI/TBI grant from the Minnesota Office of Higher Education. Devices are donated by Abbott/St. Jude. AVK holds the Endowed Chair in Rehabilitation Medicine, UBC. TEN (grant number: 17767) and MW (grant number: 17110) were recipients of Michael Smith Foundation for Health Research Trainee Awards in conjunction with the International Collaboration on Repair Discoveries and Rick Hansen Foundation, respectively.

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Authors and Affiliations



The study was conceived and designed by DPD, AP, and AVK. TIN, AP, US provided conceptual and technical guidance for all aspects of the study. IPP, TEN, CH, ZZ, JES, MW collected the data. IPP, TEN, ZZ, MC, TWD, MW, JES, and TIN performed data analysis and interpretation. IPP, TEN, MC, TWD, MW, TIN drafted the article. All authors provided critical revision of the manuscript and final approval of the version to be published.

Corresponding authors

Correspondence to Andrei V. Krassioukov or David P. Darrow.

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The authors declare no competing interests.

Ethical approval

Approval for this study was provided by the institutional review boards of both Hennepin County Medical Center and the Minneapolis Veterans Affairs Medical Center. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

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Pino, I.P., Nightingale, T.E., Hoover, C. et al. The safety of epidural spinal cord stimulation to restore function after spinal cord injury: post-surgical complications and incidence of cardiovascular events. Spinal Cord 60, 903–910 (2022).

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