Liu JT, et al. - Here, researchers identified the benefits and efficacy of spinal cord stimulation (SCS) as a therapeutic strategy for patients with perfusion problems caused by critical limb ischemia (CLI). Patient's walking ability, pain severity, and sleep quality were improved with SCS treatment in CLI patient. SCS ought to be considered as an effective treatment toward limb salvage in CLI.

Methods

• Researchers enrolled 78 patients who were diagnosed with perfusion problems between 2003–2011.
• They compared the outcomes of patients who received SCS with those of patients who did not receive SCS.
• In this study, lower-limb Thallium-201 (²⁰¹Tl) scintigraphy revealed that the patients showed a perfusion difference of <0.95.
• They adminstered SCS treatment in 37 recruited patients and 41 did not receive SCS treatment.
• All patients received the same medication (100 mg aspirin once a day and 500 mg paracetamol thrice a day).
• They measured and recorded the outcomes of walking distance, walking time, and sleeping quality.
• Using the visual analog scale (VAS) scoring system, pain intensities were evaluated.

Results

• Compared with patients in the non-SCS treatment group, patients in the SCS treatment group had worse walking distance (64.86 ± 40.80 vs 613.70 ± 535.00, p < 0.001), walking time (2.65 ± 1.64 vs 13.90 ± 11.91, p < 0.001), and sleep quality (1.70 ± 0.78 vs 3.32 ± 1.17, p < 0.001) prior to SCS implantation.
• However, patients in the SCS treatment group had significantly better walking distance (1595.00 ± 483.60, p < 0.001), walking time (48.92 ± 14.10, p < 0.001), and sleep quality (4.65 ± 0.92, p < 0.001) compared with patients in the non-SCS treatment group at the one-year follow-up.
• Furthermore, in the SCS treatment group, the VAS score of patients improved 1 week (8.63 ± 0.54 vs 4.48 ± 0.59, p < 0.001) and 1 year after SCS implantation (2.35 ± 0.62, p < 0.001).
• On the other hand, the walking distance (277.60 ± 374.80, p=0.002), walking time (9.44 ± 10.73, p=0.078), sleep quality (2.20 ± 1.10, p < 0.001), and VAS score (7.98 ± 0.43, p=0.020) of patients in the non-SCS treatment group worsened at the one-year follow-up.
• In addition, in the SCS treatment group, lower-limb ²⁰¹Tl scintigraphy revealed that microcirculation intensity increased in the lower extremities of patients after SCS implantation relative to that before SCS implantation.
• In the non-SCS treatment group, 10 of the 41 patients required the use of wheelchairs, while none of the patients in the SCS treatment group required the use of wheelchairs.