Spinal cord stimulation in peripheral arterial disease

Abstract

Percutaneous epidural stimulation of the low thoracic spinal cord was carried out in 41 patients with pain from peripheral arterial disease of the lower limbs. Results are reported relating to pain, claudication distance, peripheral blood flow, and trophic lesion changes. Following a trial period of stimulation, 37 patients had stimulators permanently implanted. After a mean poststimulation follow-up period of 25 months, substantial pain relief (75% to 100%) was obtained in 29 cases; claudication distance significantly increased in 15 cases; Doppler ultrasound recordings of lower-limb distal arteries showed a tendency toward normalization of pulse-wave morphology, with increase of amplitude in 12 of the 23 patients studied; a rise in skin temperature was also detected by thermography. Distal arterial blood pressure remained unchanged with stimulation. Ischemic cutaneous trophic lesions of less than 3 sq cm healed, but gangrenous conditions were not benefited. A placebo effect or the natural history of the disease can be excluded as the reason for these improvements. It is concluded that spinal cord stimulation is a valid alternative treatment for moderate peripheral arterial disorders when direct arterial surgery is not possible or has been unsuccessful.

Spinal cord stimulation in chronic pain syndromes

“…48 Patients with stage IV disease may respond to SCS, since ischemic ulcers 53 cm in diameter have been shown to heal well in response to stimulation. 49,50 In patients with established gangrene, no e ect from SCS will be obtained. 27,49 Studies on the e ects of SCS on peripheral vascular disease (PVD) have reported that about 80% of the patients experienced good or excellent pain relief at 1 year follow up.…”

“…49,50 In patients with established gangrene, no e ect from SCS will be obtained. 27,49 Studies on the e ects of SCS on peripheral vascular disease (PVD) have reported that about 80% of the patients experienced good or excellent pain relief at 1 year follow up. 27,49 ± 52 Patients with pain due to vasospastic disorders (Raynaud's disease) may bene®t most from SCS.…”

Perception Threshold and Electrode Position for Spinal Cord Stimulation

“…Application of electrical stimulation to the spinal cord (SCS) for alleviating intractable, chronic pain has received wide acceptance (Long and Erickson 1975;Demirel et al 1984;Broseta et al 1986;Meglio et al 1989;Devulder et al 1991;Spiegelman and Friedman 1991). The procedure entails implantation of an array of electrodes either surgically or percutaneously into the dorsal epidural space (Racz et al 1989;Barolat et al 1991).…”

Putative mechanisms behind effects of spinal cord stimulation on vascular diseases: A review of experimental studies

“…For example, a α 2 agonist, clonidine in high doses suppressed SCSinduced vasodilation. Also some patients demonstrated vasodilation with SCS even after chemical or surgical sympathectomy (Meglio et al, 1986;Broseta et al, 1986;Jacobs et al, 1988). It should be noted that, in humans, sympathectomy is rarely total.…”