Treatment of Buerger's Disease with Electrical Spinal Cord Stimulation

Abstract

Buerger's disease or obliterating thromboangiitis is an inflammatory pathologic condition affecting the distal vascular segments; it strikes young adults, especially males and heavy smokers. Medical and surgical treatment often fail to heal these patients, especially considering the frequent relapse of this disease linked with tobacco abuse--definitive healing often involves limb amputation. Electrical spinal cord stimulation is evaluated in this study with an analgesic aim and for improvement in skin microcirculation, with the goal of long-term healing of diseased limbs.

The Effects of Spinal Cord Stimulators on End Organ Perfusion: A Literature Review

“…In our extensive search, we found 4 more case reports highlighting the effects of SCS in a total of 9 patients that met the criteria of TAO that had failed first-line treatment with medications and surgical interventions such as prostaglandin-analouge Iloprost, and bypass grafting. Seven out of the total nine patients among the four reports showed resolution of ulcers, pain control not requiring narcotics, marked improvement in TcPO 2 and limb salvage [34,[38][39][40]. The remaining two patients had undergone amputation of the digits with an unclear continued nicotine use [40].…”

Thromboangiitis Obliterans

“…There are increasing reports in the literature regarding the use of implantable spinal cord stimulators in patients with TAO [143][144][145][146][147][148]. Electrical spinal cord stimulation relieves pain through several mechanisms, including preventing transmission of painful stimuli through the corresponding dermatomes, stimulation of the production of inhibitory neurotransmitters in the spinal cord, and inhibition of sympathetic vasoconstriction with consequent improvement in peripheral microcirculation [143,146,148].…”

Diagnostic Criteria and Treatment of Buerger’s Disease: A Review

“…This method of treatment achieves prolonged pain control and may help the healing of superficial ischemic ulcerations. 29,30 A literature search revealed 6 articles including a total of 38 patients with Buerger's disease treated with SCSs with very good results (Table 4); however, these findings have not been verified in randomized trials. [29][30][31][32][33][34] SCS is an option for patients with severe but stable symptoms in whom medical management failed and who are not candidates for bypass grafting.…”