The results of spinal cord stimulation in critical limb ischaemia: a review.
OBJECTIVE
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 TcpO2 baseline values (DeltaTcpO2) was > or =15 mmHg. A rise in TcpO2 after trial stimulation of at least 15% resulted in a limb salvage of 77% at 18 months (p<0.01).


CONCLUSIONS
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.
Department of Neurosurgery, Academic Hospital, Maastricht, The Netherlands.
G H
GH
Spincemaille
H C
HC
de Vet
D T
DT
Ubbink
M J
MJ
Jacobs
D000465:Algorithms; D004558:Electric Stimulation; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D018579:Patient Selection; D013116:Spinal Cord