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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

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Ongoing therapeutic benefits of intermittent thoracic spinal cord stimulation in patients with refractory angina pectoris

Meeting Abstract

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  • L. Weise - Neurochirurgische Klinik, Campus Virchow-Klinikum, Charite – Universitätsmedizin Berlin
  • H. Heinz - Klinik und Poliklinik mit Schwerpunkt Kardiologie, Angiologie und kardiovaskuläre Intensivmedizin, Campus Mitte, Charité – Universitätsmedizin Berlin
  • G.H. Schneider - Neurochirurgische Klinik, Campus Virchow-Klinikum, Charite – Universitätsmedizin Berlin
  • K. Maier-Hauff - Klinik für Neurochirurgie, Bundeswehrkrankenhaus Berlin
  • G. Baumann - Klinik und Poliklinik mit Schwerpunkt Kardiologie, Angiologie und kardiovaskuläre Intensivmedizin, Campus Mitte, Charité – Universitätsmedizin Berlin
  • S. Eddicks - Klinik und Poliklinik mit Schwerpunkt Kardiologie, Angiologie und kardiovaskuläre Intensivmedizin, Campus Mitte, Charité – Universitätsmedizin Berlin

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMI.04-04

doi: 10.3205/09dgnc186, urn:nbn:de:0183-09dgnc1865

Published: May 20, 2009

© 2009 Weise et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Several studies have shown that thoracic spinal cord stimulation is clinically effective in treating refractory angina. Despite inactivation of the stimulation device an ongoing therapeutic benefit can be observed which has been confirmed so far in animal experiments. The authors describe this effect within a prospective study.

Methods: The spinal cord stimulation electrodes were implanted in 38 patients with angina refractory to pharmacologic and revascularization therapy. The procedure was performed under local anaesthesia in a lateral decubitus position with implantation of the electrode (dorsal epidural Th1/Th2) and the pulse generator in a single step. As base line therapy all patients were treated with intermittent stimulation for two hours three times a day. At follow-up (3, 6, 12weeks and 1year) the stimulation was adjusted randomly 12hours (h) off versus 2h on prior evaluation in each patient. The therapeutic effect was assessed by pain assessment (VAS), six minute walking test, nitrate usage/24h, ergometry, and quality of life questionnaires. The On Stimulation state was compared to the pre-operative as well as the Off stimulation state.

Results: After twelve weeks the mean VAS decreased from 65 to 40, six minute walking test increased from 250 to 380 meters, and nitrate consumption was reduced from 7/day to less than 1/ day. No wearing off was observed after one year follow up. Significant benefit was already present after 3 weeks of treatment. However, after 3 and 6 weeks still a significant difference (p<0.05) could be found between the On-stimulation and the Off-stimulation group. In contrast after 12 weeks of intermittent stimulation the therapeutic effects were maintained for a period of twelve hours after discontinuing the stimulation.

Conclusions: This prospective randomized study demonstrates that the positive effects persist over twelve hours after disrupting active stimulation and confirms the therapeutic efficacy of thoracic spinal cord stimulation in refractory angina.