Treatment of severe peripheral arterial and vasospastic disease of the upper extremity by spinal cord stimulation

Abstract

Spinal cord stimulation (SCS) has been successfully introduced for treatment of severe peripheral arterial disease of the lower limbs. However, the effect of SCS for treatment of severe vasospastic disease (VD) and peripheral arterial disease (PAD) of the upper extremities remains uncertain. Therefore, the efficacy of SCS for pain reduction and increase of blood supply was studied in four patients with severe PAD and in six patients with VD of the upper limbs. Transcutaneous oxygen tension index (chest TcpO₂/hand TcpO₂), Doppler wrist pressure index (WPI), capillary microscopy (CM), and a patients pain score (PS) graded from 1 to 10 (1=no pain) were used as follow-up parameters. Pain reduction after SCS was excellent in all patients and remained significant throughout the follow-up period. TcpO₂ index decreased significantly (2.01 ± 0.79 prae-OP vs 1.57 ± 0.62 at 18 months). Capillary microscopy improved regarding red blood cell velocity and capillary density. Doppler WPI remained unchanged throughout the course. The results demonstrate that treatment of severe PAD and VD by use of thoracic SCS reduces pain significantly in these patients and increases blood supply. SCS provides a successful method of treatment for refractory VD and PAD of the upper extremity.