Spinal cord stimulation in peripheral arterial disease

A cooperative study

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✓ 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.

Article Information

Address reprint requests to: Jaime Broseta, M.D., Ph.D., Servicio de Neurocirugía, Hospital Clínico Universitario, 37007 — Salamanca, Spain.

© AANS, except where prohibited by US copyright law.

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Figures

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    Summary of clinical data and results

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    Case 12. Doppler ultrasound recordings from the left dorsal artery of the foot. Normalization of the pulse-wave morphology and increase in wave amplitude can be observed throughout the 30-minute spinal cord stimulation (SCS) period.

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    Case 10. Doppler ultrasound recordings from the left dorsal artery of the foot over a 6-month period of spinal cord stimulation (SCS). Normalization of the pulse-wave morphology and increase in wave amplitude were maintained in later studies. Recordings were made without stimulation.

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    Diagram representing the mean variation in pulse-wave amplitude throughout the 30-minute spinal cord stimulation (SCS) period as compared with baseline controls.

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    Case 7. Thermography images showing the increase in skin temperature of the left foot during a spinal cord stimulation (SCS) period. Progressive warming is represented by color changes. For color scale see Fig. 5.

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    Case 10. Thermography images showing maintenance of increased skin temperature in the left foot and lower leg 1 month after the spinal cord stimulation (SCS) program began. Readings were taken with the stimulator switched off. In the color scale, pale violet is the coldest and white the warmest. The temperature difference between two successive colors on the scale is 0.3°C.

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