| The incidence of spinal cord injury (SCI) continues to rise globally. Its high disability rates result in severe functional impairments, imposing a substantial burden on both affected individuals and society. While conventional treatments face limitations, epidural electrical stimulation (EES) has demonstrated breakthrough potential for functional recovery in recent years. However, the precise mechanisms through which EES remodels neural circuits remain incompletely elucidated. This review aims to synthesize the mechanisms by which EES improves functional deficits following SCI through neural circuit remodeling, providing a theoretical foundation for clinical translation and further research. We systematically searched literature published from database inception to 2024 in PubMed, SinoMed, Web of Science, CNKI (China National Knowledge Infrastructure), and Wanfang Data. Key search terms included “epidural electrical stimulation,” “spinal cord injury,” “circuit,” and “neural circuit.” Studies focusing on mechanistic investigations and clinical reports were selected. EES can ameliorate post-SCI functional impairments by remodeling ascending sensory pathways, descending motor pathways, and intrinsic spinal cord circuits. EES promotes functional recovery via multi-level reorganization of neural circuits, although its efficacy requires validation in large-scale randomized controlled trials. Future research should integrate single-cell sequencing and optogenetics to precisely delineate neuron subtype-specific mechanisms and explore synergistic strategies combining EES with stem cell transplantation, brain-computer interfaces, and multi-target neuromodulation. |
