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Spinal cord stimulation for non-reconstructable chronic critical leg ischaemia
1Vascular Surgery, Academic Medical Centre Amsterdam, Meibergdreef 9, P.O. Box 22700, Amsterdam, Netherlands.
The Cochrane Database of Systematic Reviews
|August 15, 2003
Summary
Spinal cord stimulation (SCS) improves limb salvage and pain relief for patients with inoperable chronic critical leg ischaemia (NR-CCLI) compared to conservative treatment alone. While costs are higher, SCS offers significant clinical benefits.
Area of Science:
- Vascular Surgery
- Neurology
- Pain Management
Background:
- Inoperable chronic critical leg ischaemia (NR-CCLI) poses a significant risk of amputation.
- Spinal cord stimulation (SCS) is explored as an adjunct to conservative treatment.
Purpose of the Study:
- To evaluate the efficacy of SCS in improving limb salvage and pain relief in NR-CCLI patients.
- To compare SCS with conservative treatment alone for clinical outcomes.
Main Methods:
- Systematic review of controlled studies comparing SCS with conservative treatment.
- Data extraction and quality assessment by independent reviewers.
- Analysis of limb salvage, pain, Fontaine stage, ulcer healing, complications, and costs.
Main Results:
- SCS significantly improved limb salvage rates (RR 0.71) and led to greater pain relief.
- More patients receiving SCS reached Fontaine stage II (RR 4.9).
- Complications occurred in 17% of SCS patients; costs were higher with SCS.
Conclusions:
- SCS demonstrates evidence favoring improved limb salvage and clinical status in NR-CCLI patients.
- Benefits of SCS should be weighed against potential mild complications and increased costs.
- Further consideration of SCS as a treatment option for NR-CCLI is warranted.
