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Spinal Cord Stimulation May Help Critical Limb Ischemia Patients Avoid Amputation

An analysis of medical literature to determine whether spinal cord stimulation (SCS) decreases lower-limb amputation found that SCS, rather than medical management alone, may help to decrease the incidence of limb amputation for some patients with critical limb ischemia (CLI), especially in patients with less severe disease. The study was conducted by researchers at the Louisiana State University (LSU) Health Sciences Center New Orleans and presented at the 2015 Annual Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine.

The researchers conducted a meta-analysis of the medical literature where the primary outcomes were studies on the incidence of limb amputation in patients who underwent SCS and studies that compared the incidence of amputation in patients who underwent SCS versus patients who used maximum medical management. They identified 289 studies by searching PubMed, MEDLINE, and other databases. The final analysis included 13 studies (595 patients).

“We found that around 34.5 percent of patients who were treated with spinal cord stimulation with critical limb ischemia eventually go on to amputation,” said Christian G. Samuelson, MD, lead author. “However, there appears to be a significant reduction of somewhere around 16 percent to 20 percent in patients with spinal cord stimulation compared to those who were treated with maximum medical management alone.” Samuelson also said that SCS for the treatment of CLI has been used for decades overseas with good results, according to Pain Medicine News.

Samuelson noted that a bias analysis of the literature suggested that there may be a significant overall underreporting of limb amputation rates in this patient population. The researchers wrote in the study that a lack of sensitivity analysis “due to the paucity of trials and variables chosen among studies” was a limitation to the study and that more research is needed to determine which subgroups of patients will benefit most from SCS.