Spinal Cord Stimulation for Critical Leg Ischemia: A Review of Effectiveness and Optimal Patient Selection

• Published in: Journal of pain and symptom management 2006-04, Vol.31 (4), p.S30-S35
• Main Authors: Ubbink, Dirk Th, Vermeulen, Hester
• Format: Article
• Language: English
• Subjects: Acute Disease; Clinical Trials as Topic - statistics & numerical data; Comorbidity; electric stimulation therapy; Electric Stimulation Therapy - statistics & numerical data; Humans; Incidence; Ischemia - epidemiology; Ischemia - therapy; Leg - blood supply; limb salvage; Pain - epidemiology; Pain - prevention & control; Patient Selection; Peripheral vascular diseases; Practice Guidelines as Topic; Practice Patterns, Physicians; skin microcirculation; Spinal Cord - physiopathology; spinal cord stimulation; transcutaneous blood gas monitoring; Treatment Outcome
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2005.12.013

Patients suffering from inoperable critical leg ischemia (CLI) ultimately face a major amputation. Spinal cord stimulation (SCS) has been introduced as a possible treatment option. This paper presents the best available evidence from a systematic review on the effectiveness of SCS in these patients and discusses the indications for SCS therapy. A meta-analysis of six controlled trials, including 444 patients, showed 11% (95% confidence interval: −0.02 to −0.20) lower amputation rate after 12 months compared to those treated with optimum medical treatment. In addition, SCS patients required significantly fewer analgesics and showed a significant clinical improvement. These positive effects have to be weighed against the higher costs and (generally minor) complications of SCS. TcpO 2 measurements were found to be useful in selecting the most respondent patients, yielding a 12-month limb salvage up to 83%. Hence, SCS should be considered as a possible treatment option in patients with CLI, particularly if their foot TcpO 2 is between 10 and 30 mmHg.