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First Objective Evidence Characterizing Differences in Cervical and Thoracic Spinal Cord Neurophysiology Using
Johnathan H Goree1, Harold Nijhuis2, Gregory L Smith3
1Department of Anesthesiology, University of Arkansas for Medical Sciences, 801 Cottage Dr, Little Rock, AR, 72205, USA. jhgoree@uams.edu.
Pain and Therapy
|October 9, 2025
Summary
Closed-loop spinal cord stimulation (CL-SCS) offers precise pain relief by adapting to individual needs. Evoked compound action potential (ECAP)-controlled CL-SCS demonstrates superior accuracy and consistency in both cervical and thoracic regions compared to open-loop systems.
Area of Science:
- Neuromodulation
- Spinal Cord Stimulation (SCS)
- Pain Management
Background:
- Open-loop (OL) spinal cord stimulation (SCS) systems have limitations in providing consistent neural activation and pain relief due to fixed parameters.
- Cervical spinal cord anatomy presents unique challenges for SCS, including reduced cerebrospinal fluid and increased mobility.
- Limited data exists comparing cervical and thoracic neurophysiology and its impact on SCS neural activation.
Purpose of the Study:
- To characterize neurophysiological differences between the cervical and thoracic spinal cord regions.
- To evaluate the impact of these differences on spinal cord stimulation (SCS) dosing and therapy optimization.
- To assess the efficacy of evoked compound action potential (ECAP)-controlled closed-loop (CL) SCS technology in managing these variations.
Main Methods:
- A post hoc analysis of global and real-world chronic pain patients implanted with ECAP-controlled CL-SCS systems.
- Analysis of the relationship between stimulation current and neural activation to identify neurophysiological differences between cervical (n=187) and thoracic (n=1899) regions.
- Evaluation of neural activation stability in both in-clinic and out-of-clinic settings during postural changes.
Main Results:
- The cervical spinal cord exhibited significantly lower ECAP thresholds and over 100% higher spinal cord sensitivity compared to the thoracic region (p < 0.001).
- The cervical therapeutic dosing range was 48% narrower, increasing the risk of overstimulation with OL-SCS.
- ECAP-controlled CL-SCS significantly improved dose accuracy in both regions (p < 0.001), especially during activities simulating daily living.
Conclusions:
- This study provides the first objective characterization of cervical and thoracic spinal neurophysiological differences in SCS.
- ECAP-controlled CL-SCS technology maintains consistent neural activation across both cervical and thoracic regions.
- Due to heightened sensitivity and a narrow dosing range, ECAP-controlled CL-SCS may offer improved therapeutic outcomes over OL systems for cervical pain.
