Background. For patients with critical limb ischaemia, spinal-cord stimulation has been advocated for the treatment of ischaemic pain and the prevention of amputation. We compared the efficacy of the addition of spinal-cord stimulation to best medical treatment in a randomised controlled trial. Methods. 120 patients with critical limb ischaemia not suitable for vascular reconstruction were randomly assigned either spinal-cord stimulation in addition to best medical treatment or best medical treatment alone. Primary outcomes were mortality and amputation. The primary endpoint was limb survival at 2 years. Findings. The mean (SD) age of the patients was 72.6 years (10.3). Median (IQR) follow-up was 605 days (244-1171). 40 (67%) of 60 patients in the spinal-cord-stimulator group and 41 (68%) of 60 patients in the standard group were alive at the end of the study, (p = 0.96). There were 25 major amputations in the spinal-cord-stimulator group and 29 in the standard group, (p = 0.47). The hazard ratio for survival at 2 years without major amputation in the spinal-cord stimulation group compared with the standard group was 0.96 (95% CI 0.61-1.51). Interpretation. Spinal-cord-stimulation in addition to best medical care does not prevent amputation in patients with critical limb ischaemia.

dx.doi.org/10.1016/S0140-6736(98)05069-7, hdl.handle.net/1765/60199
The Lancet
Department of Surgery

Klomp, H.M, Spincemaille, G.H, Steyerberg, E.W, Habbema, J.D.F, & van Urk, H. (1999). Spinal-cord stimulation in critical limb ischaemia: A randomised trial. The Lancet, 353(9158), 1040–1044. doi:10.1016/S0140-6736(98)05069-7