The results of spinal cord stimulation in critical limb ischaemia: a review

Objectives: to determine which patients with unreconstuctible critical limb ischaemia (CLI) might benefit from spinal cord stimulation (SCS). Methods: literature review. Results: limb salvage in patients with an intermediate transcutaneous oxyge n pressure (TcpO(2)) was not significantly higher with SCS (76%) than with conservative therapy (p = 0.08). However, a limb salvage of 88% was achieve d,ed with SCS if the difference between the supine and sitting TcpO(2) base line values (Delta TcpO(2)) was greater than or equal to 15 mmHg. A rise in TcpO(2) after trial stimulation of at least 15% resulted in a limb salvage of 77% at 18 months (p < 0.01). Conclusion: randomised studies show no benefit of SCS over conservative the rapy in patients with non-reconstructible CLI. However, data from experimen tal and non-randomised studies suggest this may be due to sub-optimal patie nt selection for SCS. Further trials are needed to identify subgroups who m ay benefit from SCS.