Spinal neuromodulation: a novel approach in the management of peripheral vascular disease

Since the original report about the use of spinal cord stimulation (SCS) in patients with peripheral vascular disease (PVD) over 30 years ago, its clinical effectiveness remains controversial. Animal studies have confirmed the peripheral vasodilatory effect of SCS, at least partially mediated by antidromic afferent nerve stimulation with subsequent release of vasoactive substances. Although initial studies established the therapeutic benefits of this SCS in patients with poor peripheral circulation, two recent randomized, controlled studies have failed to demonstrate any beneficial effects, raising scepticism regarding the usefulness of SCS in treating PVD. The reason for such dissimilar results is unknown, but may be the result of inappropriate or differential patient selection, or relatively small sample populations in the randomized studies. Therefore, further investigation is required to address the efficacy and indications of SCS in the treatment of peripheral ischemic vascular conditions.