Spinal cord stimulation in the treatment of severe peripheral vascular and vasospastic disorders of the upper extremity

Abstract

Objective: To evaluate the technique and results of spinal cord stimulation in patients who have intractable ischemic pain due to peripheral vascular disease, and vasospastic disorders of the upper extremity. Design: Clinical case series. The cohort underwent diagnostic evaluation and surgical intervention, and had a mean postoperative follow-up of 18.3 months. Patients and Methods: A consecutive, referred sample. Four patients had severe ischemic pain due to peripheral vascular disease and six had vasospastic disorders. Six were women and four were men, with a mean age of 45 years. All patients underwent implantation of a spinal cord stimulation system. The technique is performed under local anesthesia, using epidural puncture for electrode placement. Main outcome measures were relief of the ischemic pain for which the patient was referred, and microcirculatory skin blood flow parameters. Results: Pain relief was significant in all patients and remained significant throughout follow-up in 80% of the patients. TcPO2 values increased significantly, capillary red blood cell velocity and capillary density improved also significantly. Effects on macrocirculatory parameters were not observed. Conclusion: It is concluded that treatment of intractable ischemic pain of the upper extremities with spinal cord stimulation provides significant pain relief mainly due to effects on the microcirulatory skin blood flow.