Emerging Neuromodulation, Electrical Stimulation, and Cellular Therapies for Adult Cervical Spinal Cord Injuries in the United States: A Scoping Review.

A variety of nonsurgical modalities are used in the management of cervical spinal cord injuries (CSCIs). However, comparative analyses across these treatment modalities remain limited, hindering the development of standardized care protocols. This scoping review aimed to map the existing literature on nonsurgical interventions for CSCIs and identify trends, fundamental principles, and key gaps to inform clinical practice and future research. A scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. EMBASE, Ovid Medline, Web of Science Core Collection, and Google Scholar were systematically searched using predefined criteria. Articles were screened using Rayyan. Studies published in English between January 2004 and September 2024 involving adult patients with CSCIs and conducted in the United States were included. Sixteen studies met the inclusion criteria. Data were extracted and synthesized based on predefined parameters, and a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram was generated. Identified interventions included neuromodulation, electrical stimulation, cellular therapies, pharmacologic treatments, and exercise-based rehabilitation. Most included studies reported improvements in neurophysiological, motor, or functional outcomes. However, findings varied across interventions and largely came from small studies with heterogeneous populations, protocols, and outcome measures. These findings map the current landscape of nonsurgical therapies for CSCIs rather than establish comparative treatment effectiveness. Although several interventions showed preliminary signals of benefit, the limited volume and heterogeneity of U.S.-based evidence preclude firm conclusions about treatment effectiveness.