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J Pain Symptom Manage · Apr 2006
Review Meta AnalysisSpinal cord stimulation for critical leg ischemia: a review of effectiveness and optimal patient selection.
- Dirk Th Ubbink and Hester Vermeulen.
- Department of Clinical Epidemiology & Biostatistics, Academic Medical Center, Amsterdam, The Netherlands. d.ubbink@amc.uva.nl
- J Pain Symptom Manage. 2006 Apr 1; 31 (4 Suppl): S30-5.
AbstractPatients suffering from inoperable critical leg ischemia (CLI) ultimately face a major amputation. Spinal cord stimulation (SCS) has been introduced as a possible treatment option. This paper presents the best available evidence from a systematic review on the effectiveness of SCS in these patients and discusses the indications for SCS therapy. A meta-analysis of six controlled trials, including 444 patients, showed 11% (95% confidence interval: -0.02 to -0.20) lower amputation rate after 12 months compared to those treated with optimum medical treatment. In addition, SCS patients required significantly fewer analgesics and showed a significant clinical improvement. These positive effects have to be weighed against the higher costs and (generally minor) complications of SCS. TcpO(2) measurements were found to be useful in selecting the most respondent patients, yielding a 12-month limb salvage up to 83%. Hence, SCS should be considered as a possible treatment option in patients with CLI, particularly if their foot TcpO(2) is between 10 and 30 mmHg.
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