gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Spinal cord stimulation in peripheral arterial occlusive disease – long-term results in 91 patients

Meeting Abstract

  • J.G.V. Koster - Neurochirurgische Klinik, Klinikum Ingolstadt
  • M. Schmutzler - Neurochirurgische Klinik, Klinikum Ingolstadt
  • F.M. Müller - Chirurgische Klinik III, Klinikum Ingolstadt
  • S. Asgari - Neurochirurgische Klinik, Klinikum Ingolstadt

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.11.04

DOI: 10.3205/12dgnc258, URN: urn:nbn:de:0183-12dgnc2581

Published: June 4, 2012

© 2012 Koster et al.
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Outline

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Objective: Over a 30-year-period, epidural neurostimulation has been used to treat pain caused by different etiologies including the different types of ischemic pain. Sympatholytic activity secondarily improves blood perfusion of the tissues (tcPO2) and thus implies an improvement of the survival time of the limbs. Despite the growing number of publications, spinal cord stimulation (SCS) has not yet been established as a therapy of choice. We want to demonstrate and emphasize the success of this therapy when standard therapy (revascularization) has reached its limits.

Methods: In a retrospective single-center series, 91 patients were treated at our department between 2003 and 2008 (follow-up until 2009). Pre- and postoperatively, the severity of peripheral arterial occlusive disease (PAOD) was measured according to the Fontaine classification. In addition, ischemic pain was measured according to the VAS score before and after SCS application. Previously, all patients underwent revascularization procedures (vascular surgery or percutaneous transluminal angioplasty). Amputation rate was compared to the existing studies. "Conditio sine qua non" for an epidural neurostimulation therapy was the fact that the patients had exhausted all of the standard forms of both conservative and operative treatment.

Results: The mean age of the patients was 71 years (range, 47–96 years). 56% of the patients initially underwent revascularization surgery (e.g. bypass procedures) and 44% underwent percutaneous transluminal angioplasty before SCS. Severity of PAOD corresponded to Fontaine IIb in 7 % of patients, to Fontaine III in 45%, and to Fontaine IV in 48% of patients. According to the VAS score, pain reduction of more than a half was achieved in all patients by SCS. A major amputation had to be performed in just 7 cases (7,6%) during the follow-up period. Major amputations were performed exclusively in patients with PAOD Fontaine IV.

Conclusions: SCS is an effective tool, for reducing the extremity pain in PAOD. Moreover, SCS is able to establish the vital functions of the limbs in PAOD in a high percentage, though standard revascularization procedures were not able to stabilize the disease.