Spinal Cord Stimulation Research Articles (Page 1)

Study DesignProspective pre-post interventional study.ObjectivesTo evaluate the effects of epidural spinal cord stimulation (ESCS) combined with task-specific rehabilitation on mobility, sitting balance, bladder control, lower limb strength, and postural stability in individuals with spinal cord injury.MethodsFifteen participants with chronic thoracic SCI received daily ESCS sessions combined with physiotherapy and Tyromotion-based robotic balance training for 8 weeks. Outcome measures included: Timed Up and Go (TUG) test for mobility, Walking Index for Spinal Cord Injury II for ambulatory function, Neurogenic Bladder Symptom Score for bladder control, Manual Muscle Testing for knee extension strength, and anterior-posterior displacement for postural stability and Modified Ashworth Scale (MAS) for spasticity from.ResultsAll participants successfully completed the study. The Timed Up and Go (TUG) test time significantly improved from 430.25 ± 265.2 seconds to 141.9 ± 92.6 seconds (P < 0.001). The Walking Index for Spinal Cord Injury II (WISCI II) score increased markedly from 0.07 ± 0.26 to 6.07 ± 1.03 (P < 0.001). Antero-posterior (AP) displacement during standing balance decreased from 18.2 ± 3.5mm to 11.4 ± 2.9mm (P < 0.001), indicating enhanced static postural control. The Neurogenic Bladder Symptom Score (NBSS) improved significantly, reducing from 24.05 ± 6.91 to 7.4 ± 5.08 (P < 0.001). Manual Muscle Testing (MMT) of knee extension increased from 0.25 ± 0.44 to 3.85 ± 0.37 (P < 0.001). Finally, the Modified Ashworth Scale (MAS) scores were significantly reduced from 3.6 ± 0.257 to 1.26 ± 0. (P < 0.001), reflecting decreased lower limb spasticity.ConclusionsESCS with Tyromotion significantly improves motor strength, trunk balance, gait function, and bladder control in thoracic SCI. These findings support task-specific therapies in SCI recovery programs.

Spinal cord injury (SCI) affects motor and autonomic functions that reduce exercise capacity. Specifically, the loss of sympathetic drive following SCI at orabove the sixth thoracic segment (≥T6) can impair cardiovascular responses to exercise. This systematic scoping review aimed to identify ergogenic strategies that may augment the cardiovascular system and acutely enhance exercise performance in individuals with SCI. A systematic literature search was conducted using electronic databases (Medline, Embase, Web of Science) from inception to 1st April 2025. Studies were included if they met the following eligibility criteria: (1) human participants (aged ≥ 16years); (2) any acquired SCI (traumatic, infection, cancer); (3) any sample size but must be > 80% SCI; (4) acute, single, volitional exercise sessions with cross-over design (i.e., ergogenic strategy and control sessions); (5) report a measurable exercise performance outcome, and (6) the strategy used to enhance performance must have a theoretical effect on the cardiovascular system. Data were extracted from eligible studies and charted. Hedges' g summary effect sizes were calculated to quantify the magnitude of effects across strategies. A total of 7266 possible articles were identified. Following a full-text review, 32 articles were included. Findings were reported by strategy, defined as either mechanical (e.g., abdominal binders, lower-body compression, passive leg exercise and supine posture) or neuromodulatory [e.g., autonomic dysreflexia (AD), functional electrical stimulation (FES), pharmaceuticals/supplements/stimulants, and spinal cord stimulation (SCS)]. The neuromodulatory strategies appeared more robust at augmenting cardiovascular and performance outcomes, particularly AD, FES, and SCS. We examined methods to improve acute exercise performance by augmenting the cardiovascular system in individuals with SCI. The large heterogeneity across methodologies and outcome measures made it challenging to draw conclusions regarding the underlying physiological mechanisms. Consequently, providing definitive recommendations on the best strategies to enhance performance was not possible based on current literature. Future research should be conducted across all ergogenic strategies, with a careful focus on females, trained and untrained participants, and individuals who are more likely to benefit from improvements in cardiovascular output (i.e., SCI ≥ T6). Registration This review was pre-registered on the Open Science Framework ( https://osf.io/w7apu/ ).

Introduction: Hypertension remains a leading contributor to cardiovascular morbidity and mortality despite advances in pharmacotherapy and device-based interventions. Renal denervation (RDV) and spinal cord stimulation (SCS) have emerged as alternative therapies targeting neurohormonal pathways to achieve blood pressure control. Yet direct comparisons of their efficacy and safety in real-world populations are lacking. We aimed to compare outcomes following RDV versus SCS in hypertensive adults using a large propensity-matched cohort. Methods: We performed a retrospective cohort study through the TriNetX Global Collaborative Network, identifying adults (≥18 years) with hypertension who underwent first-ever RDV or SCS between January 2019 and October 2024. Outcomes assessed at 4-, 12-, and 26-weeks post-procedure included blood pressure targets (SBP ≤130/≤140 mm Hg; DBP ≤80/≤90 mm Hg), acute kidney injury (AKI), major adverse cardiovascular events (MACE), electrolyte disturbances (hyper-/hypokalemia, hyper-/hyponatremia), serious adverse events, procedure-related complications, and all-cause mortality. Baseline characteristics were balanced by 1:1 propensity-score matching demographics, comorbidities, and antihypertensive medications. Results: After matching (n=307 per group; 49.8 % male), SCS achieved superior blood pressure control by 12 and 26 weeks: at 12 wk DBP ≤80 mm Hg (RR 0.79; P=0.002) and combined SBP/DBP targets (RR 0.86; P&lt;0.001), and at 26 wk SBP ≤130 mm Hg (RR 0.85; P=0.044), SBP ≤140 mm Hg (RR 0.82; P=0.004), DBP ≤80 mm Hg (RR 0.84; P=0.019), and DBP ≤90 mm Hg (RR 0.84; P=0.011). RDV was associated with higher risks of hypokalemia (4 wk RR 4.10; P&lt;0.001; 26 wk RR 2.70; P&lt;0.001), serious adverse events (4 wk RR 2.12; P=0.001; 26 wk RR 1.46; P=0.005), hyponatremia (4 wk RR 4.20; P&lt;0.001; 26 wk RR 2.61; P&lt;0.001), MACE (26 wk RR 3.50; P&lt;0.001), and all-cause mortality (26 wk RR 2.40; P=0.013). Conclusion: In this large real-world cohort, SCS provided more sustained blood pressure reduction with fewer serious complications compared to RDV. These findings support consideration of SCS as a preferable neurostimulation strategy for patients with resistant hypertension.

This study combines optogenetics and retrograde transfection techniques to functionally target external urethral sphincter (EUS)-related neurons in the spinal cord and to demonstrate a proof-of-concept approach for modulating EUS activation, thereby influencing micturition. Experiments were conducted using C57BL/6 mice, in which an AAV vector (AAV2/6-eSyn-hChR2(H134R)-EGFP) was delivered to the EUS muscle, enabling retrograde transport and subsequent expression of light-sensitive proteins in motor neuron cell bodies within the spinal cord. Electromyography (EMG) of the EUS muscle in response to spinal cord photostimulation was then analyzed using fiber optics, showing that the muscle could maintain electrical activity for up to 60s during illumination under our stimulation conditions. Finally, the real-time effects of spinal cord photostimulation on micturition were assessed via cystometry. When the bladder was sufficiently filled, 60s of spinal cord stimulation extended continence time in proportion to the stimulation period (from 45 ± 8s to 101 ± 14s). These findings demonstrate that retrograde transfection from peripheral muscle to spinal motor neurons enables expression of light-sensitive proteins and allows optogenetic activation of neurons associated with the EUS. Moreover, fiber-optic stimulation effectively modulated EUS activity and micturition in situ. This electroceutical approach provides a proof-of-concept framework that may inform future strategies for treating urinary disorders and for investigating neural circuit function.

Thigh muscles activation pattern plays a key role in high-performance sprint running. We investigated spinal neural mechanisms underlying sprinters’ specific thigh muscle control by examining spinal reflex recruitment properties and reciprocal inhibition of the thigh muscles in sprinters. Ten high-level national sprinters and ten controls participated in this study. Transcutaneous spinal cord stimulation (tSCS) was used to evoke spinal reflexes in biceps femoris (BF) and soleus (SOL) muscles. To assess the recruitment properties of thigh muscles, in Experiment 1, tSCS was applied at varying intensities to analyze recruitment curves. In Experiments 2–4, reciprocal inhibition of the thigh muscles was assessed under electrical stimulation, voluntary contraction, and muscle vibration. Sprinters exhibited a significantly steeper recruitment curve slope for BF spinal reflex compared to controls, whereas the groups did not differ for the SOL. Reciprocal inhibition from the rectus femoris to BF showed no significant differences between groups. These findings suggest that spinal neural circuits in sprinters undergo plastic changes, allowing higher motor output induced by reflexes with small changes in sensory input. This sprinter-specific spinal reflex recruitment, particularly in BF, likely aligns with their specific thigh muscle activation patterns.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-22504-2.

Introduction Implantable neural devices, including brain–computer interfaces and spinal cord stimulators, hold significant therapeutic promise for conditions such as paralysis and chronic pain. However, the novelty of these technologies introduces unique ethical challenges. While much of the existing literature emphasizes development-related concerns such as device safety, the ethical issues surrounding explantation remain relatively underexplored. Methods We conducted a systematic review to identify ethical, legal, and sociocultural considerations relevant to the explantation of neural devices. The review applied the IEEE BRAIN Neuroethics framework as a guiding structure for the categorization of the themes. A subsequent thematic analysis was performed to categorize and synthesize findings across studies. Results Thematic analysis revealed that medical motives were the predominant factor in discussions of explantation, with 83% of studies citing medical complications as a central concern. Additional themes identified included changes in cognition and behavior, emotional well-being, lack of therapeutic benefit, identity, financial issues, autonomy, post-trial considerations, and neurorights. Discussion Our findings underscore the multifaceted nature of neural device explantation, extending beyond purely medical considerations to include psychological, financial, legal, and sociocultural dimensions. These results highlight the necessity of interdisciplinary approaches to adequately address the broad spectrum of challenges associated with explantation.

Spinal cord stimulation (SCS) constitutes a treatment option for patients with severe chronic pain responding insufficiently to pharmacological treatment. High device costs and expenses associated with surgical procedures and follow-up constitute a barrier to adoption. However, CNP patients also constitute a significant burden on public finances, with high public costs relating to health care utilisation, medicine, and lost work capacity. We investigated the costs of SCS therapy from a healthcare perspective (primary and secondary healthcare and medicine costs) 3 years before and 3 years after initiation of the SCS therapy in a large, mixed, well-characterised patient cohort derived from a dedicated neuromodulation registry, including patients with different diagnoses and characteristics from three of the four Danish SCS centers. We additionally compared costs of productivity loss for patients under the age of retirement. Data on societal costs were retrieved from public Danish registries. Three hundred and eight-four patients were included. Total healthcare costs 3 years after SCS were significantly higher than 3 years before SCS, with an increase of €29,835. The expenses associated with establishing SCS therapy are reflected in a sharp increase in in-patient secondary health care cost in year one after SCS. Primary health care, secondary out-patient health care and medicine costs all decrease after SCS but not enough to compensate for the cost of establishing treatment. Costs due to productivity loss remain stable throughout the period. Our findings highlight evaluating high-cost interventions within a broader cost framework to inform more efficient resource allocation in chronic pain management. This study analyzes the real-world socioeconomic impact of spinal cord stimulation (SCS) in Denmark. By using data from public Danish registries, we find a sharp increase in in-hospital expenses at the year of implantation, only partially offset by a subsequent reduction in other health care expenses and medicine costs. These findings give unique insights into the financial aspects of SCS, offering a perspective for healthcare providers, policymakers, and patients when evaluating the long-term budgetary implications of this treatment.

Motor cortex stimulation (MCS), deep brain stimulation (DBS), and spinal cord stimulation (SCS) are invasive neuromodulatory techniques that can be trialed in medically and/or surgically refractory painful trigeminal neuropathy. We aimed to assess the outcomes of MCS, DBS, and SCS in the treatment of painful trigeminal neuropathy. MEDLINE, Embase, and Cochrane Library electronic databases were searched from inception to April 2021 following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The search was rerun in April 2024. Studies were included if they reported on adults diagnosed with painful trigeminal neuropathy who underwent MCS, DBS, or SCS. The primary outcome was reduction in patient-reported pain intensity. Secondary outcomes included adverse effects. Risk of bias and study quality were assessed. Overall, 21 articles satisfied all inclusion criteria (13 MCS, five DBS, three SCS). Data were obtained for a total of 187 patients. Included diagnoses were painful trigeminal neuropathy attributed to herpes zoster, trigeminal postherpetic neuralgia, painful posttraumatic trigeminal neuropathy, painful trigeminal neuropathy attributed to other disorder, and idiopathic painful trigeminal neuropathy. Significant pain reductions were obtained with all three techniques, and some subtypes of painful trigeminal neuropathy appeared to benefit most from DBS and SCS. MCS and DBS reduced pain in painful trigeminal neuropathy, and posterior hypothalamus DBS was effective in patients with multiple sclerosis-associated pain in the V1 distribution. SCS indicated mixed results but was most effective for nondeafferentation pain. There was bias present in the one controlled trial of MCS and low-quality evidence among the remaining studies. There is promising but limited, low-quality evidence to support the use of MCS, DBS, and SCS in painful trigeminal neuropathy. Additional research is required to strengthen the evidence, improve patient selection, and determine optimal stimulation settings for the diverse range of painful trigeminal neuropathies.

Spinal cord stimulation in patients with diabetic foot: Determining prognosis using infrared thermography.

Post-inhibitory rebound excitation drives extensor activity following spinal cord stimulation.

Hierarchical Bayesian estimation of motor-evoked potential recruitment curves yields accurate and robust estimates.

Advanced Age as a Consideration in Spinal Cord Stimulation

Low back pain is treated using a multidisciplinary strategy that includes several nonsurgical interventions and analgesic medications. However, trends in nonsurgical interventions and analgesic medications used in patients with low back pain remain unclear. This study aimed to investigate trends in nonsurgical interventions and analgesic medications among patients receiving nonsurgical interventions. We conducted a retrospective cohort study using the DeSC database (DeSC Healthcare Inc.), which contains health insurance claims and health checkup data of approximately 11 million patients in August 2021. We calculated the age- and sex-adjusted rates of nonsurgical interventions and the proportions of analgesic medications used in patients who underwent nonsurgical interventions for chronic low back pain from 2015 to 2020. All trends were analyzed using the Cochran-Armitage and Jonckheere-Terpstra trend tests. The rate of nonsurgical interventions tended to increase from 1.79 to 4.21 per 100 person-years between 2015 and 2018 and declined slightly to 3.83 per 100 person-years in 2020. Nonsurgical interventions, including spinal cord stimulation, demonstrated a significant increase (p = 0.01), whereas procedures such as epidurals did not show a statistically significant increase (p = 0.19). The age-adjusted rate in females was higher than that in males after 2016. The sex-adjusted rate in patients aged ≥ 60 years showed an increasing trend. Nonsteroidal anti-inflammatory drugs were mostly used among patients receiving nonsurgical interventions; however, the proportion decreased significantly during the study period (p < 0.001). The proportion of patients using opioids was about 23%-30% and also decreased significantly (p < 0.001). The proportions of patients using acetaminophen, antiseizure medications, serotonin noradrenaline reuptake inhibitors, and tricyclic antidepressants increased significantly. The present study demonstrated an increasing trend in nonsurgical interventions, with a peak observed in 2018. Among them, interventions including spinal cord stimulation showed a significant upward trend, whereas interventions such as epidurals did not exhibit a statistically significant increase. There was a declining trend in the use of nonsteroidal anti-inflammatory drugs and opioids among these patients. These findings may inform the selection of therapeutic interventions for managing low back pain.

Individuals post-stroke demonstrate impaired motor control and muscle weakness in the paretic leg interfering their mobility. We aimed to determine whether applying spatiotemporally controlled transcutaneous spinal cord stimulation (tSCS), when combined with constraint force-induced forced use (CIFU), enhances paretic leg motor control during walking in individuals post-stroke. Thirteen individuals with stroke (age: 64.2 ± 7.1 yr old; time post-stroke: 14.1 ± 6.1 yr) were tested in a crossover design under two conditions: active versus sham tSCS during CIFU treadmill walking (tSCS + CIFU vs. sham + CIFU). In both conditions, CIFU treadmill walking was performed with a constraint force applied to the nonparetic leg during the swing phase of gait. For the active condition, tSCS was delivered at L4 during the swing phase (80 Hz) and at S1 during the stance phase (30 Hz) of the paretic leg, filled with a carrier frequency of 9.5 kHz. Spatiotemporal gait parameters, muscle activity, and propulsive force were assessed. Participants showed greater increases in paretic step length and step height in the tSCS + CIFU condition compared with the sham + CIFU condition, whereas showed prolonged paretic stance time in both conditions. The tSCS + CIFU condition also showed significantly less foot path variability of the paretic leg compared with sham + CIFU. Muscle synergy analysis revealed increased muscle weightings in plantarflexion, dorsiflexion, and hip/knee extension synergies of the paretic leg in both conditions. Propulsive force of the paretic leg showed no change in both conditions. In conclusion, applying spatiotemporally controlled tSCS during CIFU treadmill walking may enhance paretic leg motor control in individuals post-stroke.NEW & NOTEWORTHY Applying spatially and temporally controlled transcutaneous spinal cord stimulation, combined with constraint force applied to the nonparetic leg during swing, may induce greater improvements in step length and step height of the paretic leg, and reduced foot path variability in the paretic leg compared with the sham stimulation, combined with targeted constraint force during walking. These findings support the development of targeted spinal cord neuromodulation strategies to enhance paretic leg motor control in individuals post-stroke.

Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating consequence of many necessary oncologic treatments. Spinal cord stimulation (SCS) is the more common option for refractory cases, but growing evidence suggests dorsal root ganglion stimulation (DRG-S) is another viable option. This study aims to retrospectively compare the use of DRG-S and SCS to determine the modality chosen for permanent implantation for treatment of lower extremity CIPN. This is a retrospective, single-center case series in which five patients with lower extremity CIPN underwent a trial with percutaneous lead placement with an external pulse generator for both modalities. DRG-S was trialed first for five days, followed by a wash-out period of one day; next, SCS was trialed for two to five days. Treatment-induced neuropathy assessment scale (TNAS) scores were collected for each patient. A total of five patients with CIPN affecting the lower extremities met the inclusion criteria for this retrospective analysis. All patients presented with bilateral foot pain, with one patient also reporting concomitant lower back pain. The mean duration of CIPN symptoms in this cohort was approximately four years. Mean baseline TNAS score was 56.8, decreasing to 35.8 after the DRG-S trial and to 40.4 after the SCS trial. Our retrospective case series expands on the growing body of evidence supporting neuromodulation therapies for treatment-refractory chronic CIPN. Specifically, DRG-S indicates a well-tolerated treatment modality with positive clinical outcomes in alleviating isolated CIPN-related pain. Analysis also suggests the need for further research to identify optimal patient selection when considering DRG-S or conventional SCS to treat CIPN.

Chronic pain is a complex, multifactorial condition affecting millions worldwide, which is often resistant to conventional treatments. Deep brain stimulation (DBS), a reversible and adjustable neurosurgical intervention, has emerged as a promising therapeutic approach for the treatment of resistant chronic pain. This narrative review examines the evolving clinical role of DBS in pain management, highlighting its mechanisms, efficacy, limitations, and future directions. We discuss the neurophysiological underpinnings of chronic pain, emphasizing structural and functional changes in brain regions such as the medial prefrontal cortex, limbic system, and somatosensory pathways. DBS targets, including the periaqueductal/periventricular gray (PAG/PVG), the sensory thalamus, the anterior cingulate cortex (ACC), and the ventral striatum, are investigated in terms of pain modulation and affective processing. Clinical studies demonstrate significant variability in response rates, largely influenced by patient selection, lead placement, and pain etiology. While DBS shows the greatest success in nociceptive and neuropathic pain syndromes such as cluster headaches, phantom limb pain, and failed back surgery syndrome, its efficacy in deafferentation pain remains limited. Recent innovations, including dual-target stimulation, advanced imaging for surgical planning, and combination therapies with spinal cord or vagal nerve stimulation, offer promising avenues for improving outcomes. Despite its off-label status for pain in many countries, accumulating data support DBS as a viable treatment in select cases of intractable pain. Continued research and standardized protocols are essential for optimizing patient selection, refining targeting strategies, and improving long-term outcomes.

Diabetic peripheral neuropathy is a common and debilitating complication of diabetes, resulting from prolonged hyperglycemia-induced peripheral nerve dysfunction. It leads to neuropathic pain, sensory impairment, and diminished quality of life. This review summarizes the current literature available on the pathophysiology and treatment approaches for DPN. The literature search was performed in PubMed, ScienceDirect, Scopus, and Web of Science for articles published between 2009 and 2025. The search used keywords such as "Diabetic Peripheral Neuropathy," "pathophysiology," "pharmacological treatments," and "non-pharmacological treatments." Relevant data were collected from peer-reviewed journals, clinical trials, and authoritative databases. Only studies published in English were included. Studies limited to animal models or addressing other complications of diabetes were excluded. The pathogenesis of diabetic peripheral neuropathy is driven by metabolic and inflammatory changes that contribute to nerve damage and neuropathic pain. The United States Food and Drug Administration has approved pharmacological treatments for painful diabetic peripheral neuropathy: pregabalin, duloxetine, gabapentin, extended-release tapentadol, tramadol, and the capsaicin 8% patch. Non-Food and Drug Administration-approved therapies, such as amitriptyline and the 5% lidocaine patch, are also widely used. Non-pharmacological interventions, including tonic spinal cord stimulation, transcutaneous electrical nerve stimulation, manual acupuncture, local plantar vibration, and the Frequency Rhythmic Electrical Modulated System, show promise in alleviating symptoms and promoting nerve regeneration. A multifaceted approach incorporating pharmacological and non-pharmacological therapies is essential for optimizing patient outcomes in diabetic peripheral neuropathy. Targeting underlying pathophysiological mechanisms while providing symptomatic relief can enhance treatment efficacy and improve the quality of life for individuals with diabetic peripheral neuropathy.

Chronic pain involving both the spine and visceral organs can present significant treatment challenges, especially in patients refractory to pharmacologic and interventional modalities. We report a case of a male in his late 50s with chronic axial lumbar pain due to degenerative disc disease and spondylosis, in combination with severe abdominal pain related to chronic pancreatitis. The patient failed multiple conservative treatments, including systemic medications and targeted nerve blocks. Ultimately, a spinal cord stimulator (SCS) was implanted with leads positioned at T5-T7 to capture both pain regions. The patient reported substantial improvement in both axial and abdominal pain, along with reduced opioid use. This case highlights the potential role of neuromodulation in managing complex, multifocal chronic pain syndromes.

This paper systematically analyzes literature from PubMed, MEDLINE, Embase, and Cochrane databases over the past 10 years (up to May 25, 2025). It employs defined search terms, inclusion/exclusion criteria, and a documented search flow to evaluate mechanisms, efficacy, challenges, and future directions of neuromodulation technologies for spinal cord injury rehabilitation. The results synthesize findings from clinical trials, and representative papers. This review aims to evaluate the mechanisms and clinical applications of device-based neuromodulation technologies in spinal cord injury (SCI) rehabilitation, focusing on their efficacy, challenges, and future directions. The countries and regions worldwide participating in neuromodulation. We systematically analyzed advancements in neuromodulation over the past decade, including brain-spinal interfaces (BSI), brain-computer interfaces (BCI), cranial stimulation techniques (DBS, TMS, tDCS), spinal cord stimulation (SCS), robotic exoskeletons. The review integrates findings from clinical trials. Neuromodulation technologies demonstrate significant potential in restoring motor and sensory function post-SCI. BSI and BCI improve mobility but face infection and cybersecurity risks. Cranial stimulation techniques enhance neuroplasticity, with DBS and TMS showing efficacy, while tDCS requires further validation. Epidural SCS enables motor recovery in complete paralysis but has high infection rates. Robotic exoskeletons benefit younger patients. Neuromodulation technologies represent promising interventions for SCI, yet challenges remain in precision, safety, and efficacy. Future research should prioritize AI-driven parameter optimization, wearable device development, and multicenter randomized trials to establish these methods as core treatments, ultimately improving patient outcomes and quality of life.

A comprehensive review of device-related complications from cylindrical lead spinal cord stimulator (SCS) implants was previously published. [1] Although SCS remains a minimally invasive treatment for neuropathic pain, hardware-related problems such as lead migration, lead fracture, lead disconnection, generator malfunction, loss of charge, generator flipping, pocket pain, and paresthesia intolerance are reported more often than biologic complications. [1,2] Understanding these issues, their clinical presentations, diagnostic evaluation, and management strategies is critical for long-term outcomes. This infographic was designed to present the key findings of the review in a clear and accessible visual format.