Spinal Cord Stimulation in Peripheral Vascular Disease: A Retrospective Analysis of 95 Cases

Abstract

Spinal Cord Stimulation is one of the interventionist treatments used for treating diverse chronic pain syndromes. This study analyses retrospectively 95 patients diagnosed as suffering from grave peripheral arteriopathy in Fontaine state III (36 patients) and Fontaine state IV (56 patients). Eight patients required a minor amputation and 29 a major amputation. Those patients diagnosed as suffering from diabetes (diabetic arteriopathy) had a higher rate of amputation, above all those diagnosed as Fontaine group III. The most frequent complication was incorrect stimulation (22 cases), which necessitated the repositioning of the electrode.

Spinal Cord Stimulation: A 20-Year Retrospective Analysis in 260 Patients

“…The efficacy of the technique in this disease should also be assessed by the number of amputations performed in patients implanted with a stimulation system. In our series, amputation was required in only 8.1% of Fontaine stage III patients and 21% of Fontaine stage IV patients (4). The beneficial effects of stimulation in this therapy are reinforced by the increase in transcutaneous oxygen pressure and peak flow velocity, the reduction in rest pain, an increase in temperature and improvement in tissue integrity (5,31), findings which have been confirmed in studies by various groups who obtained results similar to our study (32).…”

Spinal Cord Stimulation for Chronic Limb Ischemia

“…7,8,15,16 In addition, SCS suppresses sympathetic vasoconstriction through inhibition of sympathetic nicotine transmission at the ganglionar and postganglionar level. 3,4,7 Pain relief is mediated by the suppression of pain or nociceptive transmission and the release of opioid peptides such as met-enkephalin.…”

“…Patients with pain from vasospastic disorders, frostbite, or as a result of distal arterial embolization can also be considered for therapy. 4 Critical limb ischemia (CLI) is defined as limb pain that occurs at rest or impending limb loss that is caused by a severe compromise of blood flow to the affected extremity. The annual incidence of CLI is approximately 0.25 to 0.45 patients per 1,000 population.…”

“…9 To treat lower-extremity pain in patients with CLI, 4 to 8 electrodes are generally placed in the epidural space between the thoracic 8 and 11 level through a paralaminar level 1 or 2 lumbar puncture. 4,10 The electrodes are usually centered in the spinal canal or directed off-center, depending on the location of the limb with the most significant symptoms. 18 In general, patients may often undergo a trial use of SCS to determine the optimal location of lead placement and to ascertain if the procedure provides pain relief as expected.…”

“…Patients who respond well during the trial period and achieve pain relief, improved quality of life, or increased activity become candidates for permanent lead and generator placement. 4,11 Complications from SCS include lead migration, lead connection failure, lead break, local pain, wound seroma, hematoma and infection. Hardware-related complications are the most common and can occur in 11-36% of patients, with infection being the next most common, occurring in 3-6.3% of patients.…”