Neuromodulation is a distinctive technology that modifies neural activity by delivering electrical impulses or pharmaceutical agents directly to specific regions of the brain or spinal cord. Spinal neuromodulation refers to therapeutic interventions designed to alter the activity of the spinal cord and nerve roots in order to relieve pain and other neurological symptoms. This approach primarily utilizes devices such as spinal cord stimulation systems, intrathecal drug delivery systems, and other advanced neuromodulatory technologies. Spinal neuromodulation devices function either by electrically stimulating nerves to produce natural biological responses or by administering precise, targeted doses of pharmaceutical agents directly to the site of action. These treatments have proven transformative for many patients, offering the potential for fewer side effects, greater patient comfort, and overall improvements in quality of life. The primary modalities discussed in this article include spinal cord stimulation, sacral neuromodulation, and intrathecal baclofen therapy. Spinal cord stimulation has long been a preferred treatment for chronic low back pain, chronic pain after spinal surgery, complex regional pain syndrome, and painful diabetic peripheral neuropathy. Recent technological advances have expanded its use to additional spinal disorders, and ongoing research is exploring its potential for promoting neurological recovery in individuals with paraplegia. Sacral neuromodulation is an interventional technique used to modulate sacral reflex arcs for the management of neurogenic bladder and neurogenic bowel dysfunction. Intrathecal baclofen therapy is a minimally invasive treatment indicated for severe poststroke spasticity and other forms of spasticity. This article reviews the clinical benefits of these therapies, as well as considerations related to safety, cost-effectiveness, and the quality of supporting evidence.

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STUDY DESIGN: A retrospective study. PURPOSE: To study the efficacy of augmented fixation for anatomical reduction of grade 2 and grade 3 listhesis in patients with osteoporosis. OVERVIEW OF LITERATURE: Spondylolisthesis in osteoporotic patients requiring spinal fixation are associated with complications such as loss of surgical construct stability, screw pulling out, and screw loosening. Augmented fixation is a novel strategy to achieve necessary construct integrity. METHODS: Thirteen consecutive patients with grade 2 or grade 3 listhesis, with proven osteoporosis on dual energy X-ray absorptiometry (DEXA) scan, and who underwent augmented fixation for reduction of listhesis were retrospectively analyzed. In all patients, surgical access was achieved with a fixed 22 mm tubular retractor. A modified technique of bilateral, sequential, transforaminal decompression and discectomy, followed by reduction of listhesis using unilaterally placed augmented screws was employed in all the cases. Patients were followed up with plain X-rays at regular intervals to assess for implant stability and fusion status. All patients were started on medical treatment for osteoporosis. RESULTS: The mean age of the patients was 52.46 years, with 12 females and one male. The median T-score on DEXA scan was −3.0. Of the 13 patients, listhesis was at L4–L5 in five and at L5–S1 in eight. Nine patients had grade 2 listhesis, while four patients had grade 3 listhesis. Complete reduction was achieved in 10 patients. The median duration of follow-up was 18 months. Postoperative outcomes were satisfactory in all cases. CONCLUSIONS: Augmented fixation is a useful technique for achieving anatomical reduction of listhesis in patients with osteoporosis.
Absorptiometry, Photon ; Decompression ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Male ; Minimally Invasive Surgical Procedures ; Osteoporosis ; Retrospective Studies ; Spinal Fusion ; Spondylolisthesis