gms | German Medical Science

Objective: Spinal cord stimulation (SCS) has been an approved therapy in the treatment of vascular diseases. Besides pain relief, the vasodilation effect is also known as a mode of action. In the German guide lines for the spinal cord stimulation (April 2010), neuromodulating therapy of refractory angina pectoris (AP) and peripheral arterial occlusive diseases (PAOD) are highly recommended. For other vasospastic diseases, e.g. Raynaud’s disease, neuromodulation can be considered. In systemic diseases, such as CREST syndrome (systemic sclerodermia) or critical leg ischemia (CLI), often severe vascular comorbidities are combined. We here present two cases of successful treatment with bilocular SCS (lumbar / cervicothoracal).

Methods: The first patient suffered a systemic sclerodermia with co-morbid arteriosclerosis and experienced amputation of both forefeet. In addition he presented a pronounced Raynaud’s disease with recurrent partial amputation of fingers. He complained of a combination of neuropathic, phantom and ischemic pain. He showed a concomitant depression and needed high doses of opiates. We performed implantation of both percutaneous lumbar and cervical electrodes and connected them to one device. The second patient presented CLI with upper-leg-amputation and a refractory AP. He suffered phantom pain, vascular claudication and angina at rest. In this case we implanted one lumbar and one cervicothoracal percutaneous electrode.

Results: In addition to neurostimulation, the first patient underwent a multimodal therapy (pain therapy, angiologic therapy, wound management). Finally a complete healing of the ulcers of the forefeet and fingers occurred. All pain components were significantly reduced, pain medication could also be reduced. The depressed mood and sleep improved. Thermographic examination indicated enhanced perfusion. The second patient also improved significantly. Pain medication could be reduced substantially. In the first week pain was already reduced to half of the initial pain. Implantation of only one midline electrode was sufficient to treat pain in both extremities.

Conclusions: SCS in high-risk patients suffering from combined refractory vascular diseases is an effective tool with careful indication and within an interdisciplinary setting. Neuromodulation in heavily pretreated patients can be carried out as an alternative to interventional or conservative therapy. However, it should be regarded not only as palliative but also as potentially curative method with a view to neoangiogenetic effects.