title: Spinal cord stimulation utilization to treat the microcirculatory vascular insufficiency and ulcers associated with scleroderma: a case report and review of the literature.
abstract: OBJECTIVE
  To report a case of scleroderma with associated Raynaud's phenomenon and its successful treatment with spinal cord stimulation. To demonstrate the use of transcutaneous oxygen pressure monitoring to guide the progression from trial to implantation and to assess post-implantation microcirculatory recovery.
  
  
  METHODS
  Case report and literature review.
  
  
  METHODS
  A 51-year-old female with scleroderma, associated Raynaud's phenomenon, and a non-healing 3.7-cm lower extremity ischemic ulcer. Ankle-brachial indexes demonstrated normal macrocirculation, but transcutaneous oxygen pressures demonstrated significant microcirculatory insufficiency.
  
  
  METHODS
  Treatment was a spinal cord stimulator implantation after a successful trial. Transcutaneous oxygen pressures were interpreted during the trial and post-implantation stages. Results.  Based on a 5-day trial that documented improvements in transcutaneous oxygen pressures and pain relief, the patient underwent implantation. At 4 months, the ischemic ulcer had healed. The patient had significant improvement in pain control and reduced Raynaud's phenomenon signs and symptoms. At 18 months, the patient continued to have improvement with no associated complications. A literature review demonstrated only four published reports, including a total of 18 patients, on spinal cord stimulator treatment for scleroderma and associated Raynaud's phenomenon.
  
  
  CONCLUSIONS
  We report the healing of a greater than 3-cm ischemic ulcer in an individual with normal macrocirculation but severe microcirculatory insufficiency from scleroderma. Improvements in microcirculation correlated with wound healing. Spinal cord stimulation may be considered for select individuals with microcirculatory reserves that can be modulated with treatment.
authors.affiliation: Institute for Pain Diagnostics and Care, Ohio Valley General Hospital, 500 Pine Hollow Road, McKees Rocks, PA 15136, USA. davidprovenzano@hotmail.com
authors.forename: David A
authors.initials: DA
authors.lastname: Provenzano
authors.forename: Luke
authors.initials: L
authors.lastname: Nicholson
authors.forename: Gaye
authors.initials: G
authors.lastname: Jarzabek
authors.forename: Evan
authors.initials: E
authors.lastname: Lutton
authors.forename: David B
authors.initials: DB
authors.lastname: Catalane
authors.forename: Eileen
authors.initials: E
authors.lastname: Mackin
mesh_terms: D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007871:Leg Ulcer / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D055806:Microvessels / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D013116:Spinal Cord / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery*