Clinical and objective data on spinal cord stimulation for the treatment of severe Raynaud's phenomenon

Ischemic vascular disease of the upper extremity represents a difficult the rapeutic problem wherein medical treatment often fails. Epidural spinal cor d stimulation has been shown to be an effective alternative in severe perip heral arterial disease. Although this method has been used for nearly two d ecades only limited experience exists in Raynaud's phenomenon of the upper limbs. In addition objective parameters to prove therapeutic success are no t well defined. Herein we describe a patient with severe primary Raynaud's phenomenon over several years who had significant pain relief and complete healing of ischemic digital ulcerations after spinal cord stimulation. Pain level was evaluated using a visual rating scale before and after surgery. Microcirculatory parameters were assessed before and after spinal cord stim ulation by capillary microscopy and laser Doppler anemometry. Significant i mprovement of red blood cell velocity, capillary density, and capillary per meability was demonstrated. At follow-up 18 months after surgery the patien t had no complaints and all ulcerations of her fingertips had healed. Spina l cord stimulation appears to be an effective treatment in severe cases of Raynaud's phenomenon and we recommend its use in the case of failed medical therapy. Pain rating and capillary microscopy enable one to assess and vis ualize the effects of spinal cord stimulation.