The Closed Loop Revolution

This presentation explores the transformative impact of closed-loop spinal cord stimulation (SCS) using evoked compound action potentials (ECAPs). Unlike traditional open-loop systems, which blindly deliver constant stimulation despite anatomical or physiological changes, closed-loop technology continuously adjusts output in real time, maintaining optimal activation within a patient’s therapeutic window. Clinical trials, especially the EVOKE trial, demonstrated superior long-term outcomes, including pain relief, improved function, and reduced opioid use. The future of neuromodulation lies in expanding closed-loop applications to non-tonic waveforms like burst and high-frequency stimulation, enhancing personalization and effectiveness across diverse pain conditions.