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Spinal Cord Stimulation for Intractable Chronic Limb Ischemia: A Narrative Review
Roberto Gazzeri1, Tommaso Castrucci2, Matteo Luigi Giuseppe Leoni3
1Interventional and Surgical Pain Management Unit, San Giovanni-Addolorata Hospital, Via Amba Aradam 9, 00184 Rome, Italy.
Insights
Spinal cord stimulation (SCS) offers a safe and effective treatment for critical limb ischemia (CLI) when revascularization fails. This therapy can improve outcomes for patients with severe peripheral arterial disease.
Area of Science:
- Vascular Surgery
- Neuromodulation
- Peripheral Arterial Disease Management
Background:
- Critical limb ischemia (CLI) represents the most severe stage of peripheral arterial disease (PAD), leading to significant morbidity, mortality, and reduced quality of life.
- CLI complications include severe limb pain, impaired mobility, ulcerations, and potential amputations.
- Current treatment options for CLI are limited, especially when surgical or endovascular revascularization is not feasible or has failed.
Purpose of the Study:
- To review the current evidence on spinal cord stimulation (SCS) as a treatment for CLI.
- To explore the surgical techniques, emerging SCS modalities, and mechanisms of action relevant to vascular diseases.
- To define patient selection criteria, clinical outcomes, and potential complications associated with SCS for CLI.
Main Methods:
- Systematic review of existing literature on SCS for CLI.
- Analysis of surgical approaches and technological advancements in SCS.
- Evaluation of studies investigating SCS mechanisms, patient selection, and clinical results.
Main Results:
- Spinal cord stimulation (SCS) is presented as a viable therapeutic option for selected CLI patients unresponsive to conventional treatments.
- The precise vasodilatory mechanisms of SCS in the peripheral microcirculation require further elucidation.
- Clinical outcomes data for SCS in CLI are variable, necessitating careful patient selection and further research.
Conclusions:
- Spinal cord stimulation (SCS) is a safe and effective surgical intervention for specific CLI patients ineligible for revascularization.
- Further research is needed to fully understand SCS's mechanism of action in vascular diseases and optimize its application in CLI.
- SCS offers a promising alternative for managing intractable pain and potentially improving limb salvage in advanced CLI.
Abstract:
Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease, significantly impacting quality of life, morbidity and mortality. Common complications include severe limb pain, walking difficulties, ulcerations and limb amputations. For cases of CLI where surgical or endovascular reconstruction is not possible or fails, spinal cord stimulation (SCS) may be a treatment option. Currently, SCS is primarily prescribed as a symptomatic treatment for painful symptoms. It is used to treat intractable pain arising from various disorders, such as neuropathic pain secondary to persistent spinal pain syndrome (PSPS) and painful diabetic neuropathy. Data regarding the effect of SCS in treating CLI are varied, with the mechanism of action of vasodilatation in the peripheral microcirculatory system not yet fully understood. This review focuses on the surgical technique, new modalities of SCS, the mechanisms of action of SCS in vascular diseases and the parameters for selecting CLI patients, along with the clinical outcomes and complications. SCS is a safe and effective surgical option in selected patients with CLI, where surgical or endovascular revascularization is not feasible.
