Structural and Functional Impact of Spinal Cord Stimulation in Diabetic Peripheral Neuropathy

Area of Science:

• Neurology
• Diabetology
• Biomedical Engineering

Background:

• Diabetic peripheral neuropathy (DPN) is a common diabetes complication causing pain and functional loss.
• Current treatments for DPN primarily manage symptoms, with limited understanding of disease modification.

Purpose of the Study:

• To review the evidence on spinal cord stimulation (SCS) for its potential to modify DPN pathology.
• To elucidate SCS's role in mitigating structural and functional changes in DPN.

Main Methods:

• Systematic literature search of PubMed (1990-2025) for SCS effects in DPN.
• Inclusion of 22 studies examining structural, functional, vascular, or biochemical impacts.
• Thematic data extraction across five domains: peripheral nerve, spinal plasticity, supraspinal modulation, neuroinflammation, vascular/metabolic effects.

Main Results:

• SCS improved functional and structural biomarkers in DPN patients and preclinical models.
• Clinical studies showed enhanced nerve conduction, increased nerve fiber density, and corneal nerve regeneration.
• Preclinical data indicated suppressed neuroinflammation, restored neurotrophic signaling, and improved microcirculation.

Conclusions:

• SCS offers multimodal benefits, restoring neural integrity and mitigating DPN progression.
• Findings suggest SCS as a potential disease-modifying therapy for DPN.
• Further mechanistic trials are needed to optimize SCS for DPN treatment.