Spinal cord stimulation (SCS) is a treatment that has been successfully used for many years by pain specialists and neurosurgeons. New indications have been found for the device over the years and it is increasingly successfully used in the treatment of peripheral vascular disease (PVD) and ischemic heart disease (IHD), though this is not widely known in South Africa.
Dr Russel Raath, an anaesthesiologist specialising in pain management at the Netcare Jakaranda Hospital in Pretoria, says that SCS is not extensively used for these indications in South Africa largely because its benefits have not been widely recognised and heart and vascular surgeons are not familiar with it. The benefits of SCS have been made evident in a number of scientific studies, however.1 Dr Raath points out that in selected patients with PVD it improves blood flow and stimulates the growth of new capillaries.
Patients may need coronary bypass surgery to bypass occlusions in the larger coronary vessels, but some also suffer from peripheral or micro vascular disease, which is disease of the very small vessels in the heart muscle that cannot be bypassed, notes Dr Raath. This small vessel disease can be deadly and until now the only treatment has been drugs which are not always effective in all patients.?
The same situation may occur in the micro vessels of the peripheral limbs, he continues. SCS has been shown to improve blood flow to the myocardium and limb muscles and complements vascular surgery in certain patients. This is a treatment that saves limbs and lives.
SCS was used in the treatment of IHD and PVD in Europe from the 1970s and 1980s respectively.1 SCS has been shown to have beneficial effects for both PVD and IHD. It improves the quality of life of PVD patients who are often severely disabled.1 Used as an additional treatment for IHD, SCS reduces angina pectoris in both its frequency and intensity and has also demonstrated an anti-ischemic effect.
In 2009, a 20-year retrospective analysis suggested there was a 90% improvement in PVD patients who were treated with SCS. These excellent results suggest to us that SCS be considered as a first-line approach to the clinical management of patients with [PVD related] pain and ulcer, wrote the authors. We only anticipate a greater future for this technique as the technology improves, the indications for the therapy advance, and [we update our] knowledge base as we gain more experience.
SCS has also proved highly beneficial in the treatment of patients with angina pectoris who have not responded well to conventional treatment modalities. SCS treatment has been shown to give patients significant relief of angina, reduced frequency of attacks, improved quality of life and it reduces the need for short-acting nitrates.
It is important for vascular and heart specialists to know that this life-saving treatment modality is available at centres such as the Netcare Jakaranda Hospital, so they are aware options are available even when these may appear limited,? concluded Dr Raath. ?There is also a need for more clinicians to learn this exciting technique so that it may be offered more widely in this country.
1. J de Vries, MJL Jongste, et al: Spinal cord stimulation for ischemic heart disease and peripheral vascular disease, Advances and Technical Standards in Neurosurgery, Vol 32, 2007; 64.
2. E Reig, D Abej?n: Spinal cord stimulation: A 20-year retrospective analysis in 260 patients, Neuromodulation: Technology at the Neural Interface, 2009, Vol 12, No 3; 232-234.
3. P Andrll, O Ekre, et al: Cost-effectiveness of Spinal Cord Stimulation versus coronary artery bypass grafting in patients with severe angina pectoris ? long-term results from ESBY Study, Cardiology, 2003; 20.
Issued by : Martina Nicholson Associates (MNA) on behalf of Netcare Jakaranda Hospital
Contact : Martina Nicholson or Graeme Swinney
Telephone : (011) 469 3016
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