Spinal cord neuromodulation for autonomic recovery following spinal cord injury: a scoping review

Background Spinal cord injury (SCI) disrupts autonomic control, leading to cardiovascular, bowel, lower urinary tract (LUT), and sexual dysfunctions. Spinal cord stimulation (SCS) has shown therapeutic promise, but a comprehensive review of its effects on autonomic recovery after SCI has not been performed. Purpose To synthesize evidence on the effects of SCS on autonomic functions, specifically cardiovascular, bowel, LUT, and sexual function, in animal models and individuals with SCI. Data sources PubMed, EMBASE, and Web of Science; from date of inception to September 2025. Study selection Studies were included if they investigated the effects of SCS on cardiovascular, bowel, LUT, or sexual function in humans or animals with SCI. Of 2079 studies screened, 68 met inclusion criteria: 15 animals, 50 humans, and 3 involving both species. Data extraction Data were independently extracted, and final inclusion decisions were reached by consensus among authors. Data synthesis Both animal and human studies show that SCS enhances autonomic function after SCI. It improves bladder control, cardiovascular stability, and bowel motility in animals; and additionally alleviates neurogenic bowel symptoms, increases bladder capacity and compliance in humans. Improvements in sexual function were observed in both animal and human studies. Limitations Evidence primarily comprises case reports, case series, and cohort studies, with few controlled trials. Mechanistic studies remain limited, and methodological heterogeneity restricts comparisons. Conclusions SCS shows promise in improving autonomic dysfunction after SCI and enhancing quality of life. These findings inform priority areas for RCTs and mechanistic studies to optimize protocols and patient selection.