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Spinal cord stimulation for non-reconstructable chronic critical leg ischaemia
1Department of Vascular Surgery, University of Amsterdam, J1b-215 Academic Medical Center, Meibergdreef 9, PO Box 22700, Amsterdam, Netherlands, 1100 DE. D.Ubbink@amc.uva.nl
The Cochrane Database of Systematic Reviews
|July 22, 2005
Summary
Spinal cord stimulation (SCS) improves limb salvage and pain relief for patients with inoperable chronic critical leg ischaemia (NR-CCLI). While complications and costs are higher, SCS offers significant clinical benefits over conservative treatment alone.
Area of Science:
- Vascular Surgery
- Neurology
- Pain Management
Background:
- Inoperable chronic critical leg ischaemia (NR-CCLI) often leads to amputation.
- Spinal cord stimulation (SCS) is a potential adjunctive therapy to conservative treatment.
Purpose of the Study:
- To evaluate the efficacy of SCS in improving limb salvage, pain relief, and clinical status in NR-CCLI patients.
- To compare SCS plus conservative treatment against conservative treatment alone.
Main Methods:
- Systematic review of controlled studies comparing SCS with conservative treatment for NR-CCLI.
- Data extracted and quality assessed independently by two authors.
- Searched Cochrane Peripheral Vascular Diseases Group's Register and CENTRAL (up to May 2005).
Main Results:
- Six studies with ~450 patients showed significantly higher limb salvage at 12 months with SCS (RR 0.71).
- SCS provided more prominent pain relief and reduced analgesic requirements.
- More patients achieved Fontaine stage II with SCS; ulcer healing showed no significant difference.
- SCS complications occurred in 17% (implantation, re-intervention), with a number needed to harm of 6.
- Two-year costs were higher with SCS (€36,500) vs. conservative treatment (€28,600).
Conclusions:
- Evidence supports SCS as superior to conservative treatment for improving limb salvage and clinical outcomes in NR-CCLI.
- Benefits of SCS must be weighed against potential mild complications and increased costs.
