REVIEW ARTICLE
The Results of Spinal Cord Stimulation in Critical Limb Ischaemia:a Review

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Abstract

Objectives: to determine which patients with unreconstructible critical limb ischaemia (CLI) might benefit from spinal cord stimulation (SCS). Methods: literature review. Results: limb salvage in patients with an intermediate transcutaneous oxygen pressure (TcpO2) was not significantly higher with SCS (76%) than with conservative therapy (p=0.08). However, a limb salvage of 88% was achieved with SCS if the difference between the supine and sitting TcpO2baseline values (ΔTcpO2) was ≥15 mmHg. A rise in TcpO2after trial stimulation of at least 15% resulted in a limb salvage of 77% at 18 months (p<0.01). Conclusion randomised studies show no benefit of SCS over conservative therapy in patients with non-reconstructible CLI. However, data from experimental and non-randomised studies suggest this may be due to sub-optimal patient selection for SCS. Further trials are needed to identify subgroups who may benefit from SCS.

Keywords

Critical limb ischaemia
Spinal cord stimulation
Microcirculation
TcpO2.

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Please address all correspondence to: G. H. J. J. Spincemaille, Department of Neurosurgery, University Hospital AZM, P. Debyelaan 25, 6202 AZ Maastricht (NL).