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Spinal Cord Stimulation

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Critical Limb Ischemia

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Abstract

Critical limb ischemia (CLI) is treated with surgical or endovascular technique to restore blood flow as distally as possible. Neuromodulation in the form of spinal cord stimulation (SCS) is offered to patients who have severe debilitating chronic pain and who are not amenable to conventional drug therapy or surgical bypass. SCS delivers small electrical fields to the spinal cord, which mask areas of pain by changing the pain messages to the brain. Additionally, the ischemic pain is thought to be relieved due to complementary mechanisms of antidromic vasodilation and decreased sympathetic efferent activity. For SCS implantation, patients should be 18 years of age or older, be willing to stop or reduce excessive medication, and be able to manage the technical demands of the equipment. The primary purpose of SCS is to improve QOL by reducing the severity of pain. Obvious contraindications are anatomical problems when it is not possible to implant a spinal cord stimulation system safely, active infective illness or local site infection, or psychiatric illnesses/untreated drug addiction/metal allergy. Common complications of SCS include painful battery/connection site, infection (less than 5 %), and unpleasant stimulation/decrease in pain relief with time. This brief review suggests that SCS results in pain relief, improved quality of life (QOL), healing of ulcers, and reduced amputation rates; however, more objective studies focused on assessment of microcirculatory blood flow of skin; before and after SCS are needed to quantify its efficacy in improving circulation. SCS should be offered in an environment of multidisciplinary pain management, in parallel with other therapies and should be used as part of an overall rehabilitation strategy.

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Author information

Authors and Affiliations

  1. Department of Surgery, NSCB Government Medical College, Garha, Nagpur Road, Jabalpur, 482003, MP, India

    Pawan Agarwal MS, MCh, DNB, MNAMS, PhD

  2. Department of Surgery, Government NSCB Medical College, Nagpur Road, Garha, Jabalpur, 482003, MP, India

    Dhananjaya Sharma MS, PhD, DSc

Authors
  1. Pawan Agarwal MS, MCh, DNB, MNAMS, PhD
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  2. Dhananjaya Sharma MS, PhD, DSc
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Editor information

Editors and Affiliations

  1. Loyola University Medical Center, Maywood, Illinois, USA

    Robert S. Dieter

  2. Northwestern Medicine Central DuPage Hospital, Glen Ellyn, Illinois, USA

    Raymond A. Dieter, Jr

  3. The University of Tennessee Medical Center, Knoxville, Tennessee, USA

    Raymond A. Dieter, III

  4. West Virginia University, Charleston, West Virginia, USA

    Aravinda Nanjundappa

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© 2017 Springer International Publishing Switzerland

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Agarwal, P., Sharma, D. (2017). Spinal Cord Stimulation. In: Dieter, R., Dieter, Jr, R., Dieter, III, R., Nanjundappa, A. (eds) Critical Limb Ischemia. Springer, Cham. https://doi.org/10.1007/978-3-319-31991-9_41

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  • DOI: https://doi.org/10.1007/978-3-319-31991-9_41

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-31989-6

  • Online ISBN: 978-3-319-31991-9

  • eBook Packages: MedicineMedicine (R0)

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