The use of spinal cord stimulation for severe limb-threatening ischemia: a preliminary report

Spinal cord stimulation has been shown to control ischemic pain. We have applied spinal cord stimulation to nine patients with rest pain, non-healing ulceration, or digital gangrene to evaluate its effect on limb salvage. The patients had a mean age of 69 years. Six were diabetic, and all had previous major complications of their atherosclerotic disease. Stimulation was obtained by placing an electrode on the spinal cord under local anesthesia. Seven patients experienced marked reduction in their ischemic pain immediately after stimulation. These patients also had improved healing of ulcers documented by direct measurement. No significant change in ankle/brachial Doppler indices could be measured in any patient. One patient became suddenly worse and required amputation after one year of good pain relief and ulcer improvement. Two patients were not helped and went on to amputation within one month of stimulation. We conclude from these preliminary data that spinal cord stimulation effectively relieves ischemic pain and is associated with improved ulcer healing.