Technical data and complications of spinal cord stimulation: data from a randomized trial on critical limb ischemia.
This study was done to evaluate the effect of spinal cord stimulation (SCS) on critical limb ischemia and to report technical problems and complications. One hundred and twenty patients with critical limb ischemia were eligible for randomization between medical treatment and medical treatment plus SCS. Sixty received a spinal cord stimulator (Itrel II; Medtronic, Minneapolis, Minn., USA). Primary outcome measures were limb salvage and pain relief. The mean pain reduction in both treatment groups was 50% (from 5 to 2.5 on the visual analog scale). The 2-year limb survival was 52% (SCS) versus 46% (standard treatment; p = 0.47). The number of patients undergoing major amputations in the SCS group with intermediate TcpO2 values was half of that in the standard group (14 vs. 28; 24 vs. 48%; p = 0.17). Implantation was successful in 51 patients. Technical problems such as loss of stimulation due to lead displacement occurred in 13 patients (22%), local infection at the site of implantation occurred in 3 patients (5%), resulting in a total complication rate of 27%. Premature depletion of the battery occurred within 2 years in 3 patients (5%). There were no lead fractures, epidural infections, hematoma or cerebrospinal fluid leakage. Training of physicians and better reliability of the hardware should reduce the frequency of technical problems. Lead displacement remains the major technical problem. The search for prognostic factors of limb salvage is important. One microcirculatory measurement (TcpO2) seems to have a prognostic value, which remains to be described more precisely.
Department of Neurosurgery, University Hospital Maastricht, The Netherlands. gspi@snch.azm.nl
G H
GH
Spincemaille
H M
HM
Klomp
E W
EW
Steyerberg
H
H
van Urk
J D
JD
Habbema
D000368:Aged; D000671:Amputation, Surgical; D001157:Arterial Occlusive Diseases / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000503:physiopathology / Q000628:therapy; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007511:Ischemia / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D007866:Leg / Q000098:blood supply; D008297:Male; D008833:Microcirculation; D010146:Pain / Q000209:etiology; D059408:Pain Management; D011788:Quality of Life; D012867:Skin / Q000098:blood supply; D013116:Spinal Cord; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome