Limitations of Current Closed-Loop SCS Systems and Comparison Against Non-Tonic SCS Modes

Neuromodulation incorporating physiologic feedback from stimulated biologic targets to adjust output has been used for a while in cardiac pacemakers and deep brain stimulators but it is a relatively new development in spinal cord stimulation (SCS). Though early research has indicated the potential for more effective stimulation with closed-loop SCS while avoiding unwanted stimulation, questions abound about effectiveness and durability of closed-loop SCS. Further, as the algorithm for closed-loop SCS was developed with low-frequency tonic stimulation, it's potential use with higher frequency SCS modes remains unclear. This session will focus on enumerating the modalities for adaptive SCS, understanding the algorithms of closed-loop SCS including evoked compound action potentials, discussing the evidence for its efficacy, and exploring its role with higher frequency modes of SCS. The speakers in this session have clinical and research experience in evaluating new modes of SCS, explaining the applicability of closed loop SCS to the audience, identifying the lacunae in evidence, and proposing areas for further research.