Objective:

To review the pathophysiological basis of spinal cord injury (SCI), the neural mechanisms underlying epidural electrical stimulation (EES), its clinical efficacy, and combined therapeutic approaches.

Approach:

• Narrative Review: The study narratively reviews the mechanisms, efficacy, and limitations of EES in enhancing lower extremity motor function in SCI patients.

Key Findings:

• EES can increase spinal motor network excitability and improve lower extremity functions such as standing, stepping, walking, and spasticity control.
• EES shows potential benefits in patients with chronic incomplete SCI and in a subset of those classified as having motor-complete SCI.
• Therapeutic benefits of EES are influenced by factors such as injury severity, stimulation parameters, electrode configuration, and rehabilitation intensity.

Interpretation:

EES may promote functional recovery in patients with chronic incomplete SCI and in some with motor-complete SCI, but its effectiveness is influenced by various patient-specific and technological factors.

Limitations:

• Current evidence is limited by small sample sizes and study heterogeneity.
• Further research is needed in multicenter randomized controlled trials, standardized outcome assessments, closed-loop programming, and long-term safety evaluations.

Conclusion:

Further studies are required to establish the clinical application of EES for enhancing lower extremity function in SCI.