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Spinal cord stimulation for non-reconstructable chronic critical leg ischaemia
Dirk T Ubbink1, Hester Vermeulen
1Quality Assurance & Process Innovation, and Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam,Netherlands.d.ubbink@amc.uva.nl.
The Cochrane Database of Systematic Reviews
|March 2, 2013
Summary
Spinal cord stimulation (SCS) improves limb salvage and clinical outcomes for patients with inoperable chronic critical leg ischaemia (NR-CCLI). While effective for pain relief, SCS has associated complications and higher costs compared to conservative treatment alone.
Area of Science:
- Vascular Surgery
- Neuromodulation
- Evidence-Based Medicine
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 compared to conservative treatment alone.
Main Methods:
- Systematic review of controlled studies comparing SCS plus conservative treatment versus conservative treatment alone.
- Cochrane Peripheral Vascular Diseases Group searched specialized registers and CENTRAL up to January 2013.
Main Results:
- Six studies (approx. 450 patients) showed significantly higher limb salvage at 12 months with SCS (RR 0.71).
- SCS provided significant pain relief and reduced analgesic requirements.
- More patients achieved Fontaine stage II with SCS (RR 4.9), but ulcer healing showed no significant difference.
- Complications occurred in 17% of SCS patients (NNH 6), with higher average costs (EUR 7900 difference).
Conclusions:
- Evidence supports SCS as a beneficial addition to conservative treatment for improving limb salvage and clinical status in NR-CCLI.
- The benefits of SCS must be weighed against potential complications and increased costs.
