Factors of adverse prediction of application of spinal cord stimulation with chronic pain syndrome in patients with critical lower limb ischemia

Objective. To study the clinical dynamics in the long-term period after spinal cord stimulation (SCS) in patients with chronic pain syndrome and critical lower limb ischemia (CLLI) and to identify factors affecting the prognosis of SCS. Material and methods. The clinical dynamics was analyzed in 48 patients with pain syndrome and CLLI 1 year after SCS. Micro-circulatory blood flow (MBF) was studied in the affected foot by laser-doppler flowmetry (LDF) (Perfusion Units (PU)) and transcu-taneous oximetry (ТсрО₂, mmHg.) using an occlusive test before and after SCS. The factors associated with negative clinical dynamics 1 year after SCS were determined. Results. In 74% of cases, SCS contributes to the improvement of clinical status (reduction of pain syndrome, increase in motor activity, healing of ulcers). After SCS, according to LDF and ТсрО₂, the authors observed an increase in MBF and tissue metabolism — from 1.3 (0.7—2.8) to 6.2 (3.8—8.7) PU and from 14.5 (7.5—22.1) to 41.1 (26.4—57.6) mmHg, respectively with normalization of the MBF reserve during the occlusion test. Negative clinical dynamics after SCS is associated with high comorbidity, TcO₂ <10 mmHg and the duration of pain. Conclusion. SCS contributes to the improvement of the clinical status of patients with chronic pain syndrome and CLLI. The negative dynamics is associated with high comorbidity, TcrO₂ <10 mmHg and the duration of pain.