Spinal Cord Stimulation for Ischemic Limb Pain
Alexander E. Yakovlev, Comprehensive Pain Management of The Fox Valley, SC, Appleton, Wis. Sergey A. Karasev, MD, Comprehensive Pain Management of The Fox Valley, SC, Appleton, Wis. Emil Isagulyan, The N.N. Burdenko Institute of Neurosurgery of RAMS, Moscow, Russian Federation Beth E. Resch, APNP, Comprehensive Pain Management of The Fox Valley, SC, Appleton, Wis. Victoria Yakovleva, Comprehensive Pain Management of The Fox Valley, SC, Appleton, Wis.
INTRODUCTION
Patients with peripheral arterial disease may suffer from intractable pain and functional incapacitation despite medical therapies and surgical interventions. Treatment of these patients is often a challenge because the co-morbidities related to systemic atherosclerosis. The pain is often disabling, affecting quality of life and limiting their activities. Alternative treatments have to be developed to improve potential for limb salvage and to relieve ischemic pain.
METHODS
Between September 2007 and May 2009, 12 patients with ischemic leg pain who had failed conservative treatment, surgical interventions and sympathetic blocks underwent successful trial of percutaneous placement of two 8-electrode epidural leads positioned at T9-T10-T11 level. During SCS trial the patients reported >80% improvement of the leg pain. Two weeks later the patients underwent implantation with permanent leads and RestorePRIME non rechargeable or RestoreULTRA (Medtronic Inc.) rechargeable generators.
FIGURES
RESULTS
After final implantation the patients had excellent pain relief for 12 months (VAS scores 1-4 out of 10). They were able to discontinue use of all oral pain medications, had improvement of functional capacity and reported increased claudication distance increased from less than 20-50 m to 80-500 m. All patients were amputation free.
CONCLUSIONS
SCS can be an effective option in the management severe ischemic limb pain and lead to functional improvement for patients who have exhausted medical, surgical and interventional treatment options.
REFERENCES
1. Ghajar AW, Miles JB. The differential effect of the level of spinal cord stimulation on patients with advanced peripheral vascular disease in the lower limbs. British Journal of Neurosurgery 1996: 12: 402-408.
2. Tiede JM, Huntoon MA. Review of spinal cord stimulation in peripheral arterial disease. Neuromodulation 2004: 7: 168-175.
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