Spinal cord stimulation in diabetic lower limb critical ischaemia: Transcutaneous oxygen measurement as predictor for treatment success

Objectives: to evaluate whether transcutaneous oxygen tension (TcpO(2)) mea surements could be used as a specific pognostic parameter in selecting diab etic patients for permanent device implantation. Methods: sixty consecutive diabetic patients (28 with autonomic neuropathy) , classified as Fontaine stage III or IV, underwent spinal cord stimulation (SCS) for ischaemic pain, after failed conservative of surgical treatment. Pedal TcpO(2) on the dorsum of the foot and ankle-pressure Doppler measure ments were preformed before, and 2 and 4 weeks after implantation. Results: limb salvage and good pain relief were achieved in 35 patients, wh ile in 12 partial pain relief and limb salvage for at least 6 months were o btained. In 13 patients the method failed and the ischaemic limbs were ampu tated. Only 3 of the 28 patients with neuropathy had any long-term benefit. Limb salvage was achieved in those patients with a significant increase in TcpO(2) within 2 weeks of stimulation. The stage of the neuropathy was inv ersely related to the success of SCS therapy. The ankle-brachial pressure i ndex (ABPI) did not change after stimulation. Conclusion: diabetic patients with significant increase of TcpO(2) and pain relief during a 2-week test period may be successfully treated by long-ter m SCS unless they have advanced autonomic neuropathy.