SPINAL CORD STIMULATION IN BUERGER’S DISEASE – A CASE REPORT

Abstract

Buerger’s disease (BD) or thromboangeitis obliterants is a nonatherosclerotic segmental inflammation of the medium- and small-size arteries and vessels of the extremities. The pathogenesis of this process remains unclear. This disease is typically seen in male smokers under 45 years of age, and successful therapy is possible only with abstinence from tobacco. Methods to control ischemic pain include nonpharmacological and pharmacological options, such as prostanoids, or surgical intervention (sympathectomy or revascularization). This case report describes an unusual case of Buerger’s disease in a 60-year-old woman with a moderate smoking habit. Despite apparent tobacco abstinence and therapeutic optimization, there was no clinical improvement in this patient with pharmacological treatment. Attending to the imminent risk of amputation of her fingers, spinal cord stimulation (SCS) system implantation was the chosen therapeutic option. Transcutaneous oxygen pressure (TcPO2) was measured at different points in time after implantation and there was a significant increment of TcPO2 in both hands. In fact, the patient reported no pain after the first month of spinal stimulation; analgesics were progressively reduced and complete healing of ulcers was achieved. Furthermore, the patient reported a substantial improvement in her quality of life and total functional recovery in her hands mobilization after 6 months of treatment. The Brief Pain Inventory Scale and EuroQol- 5D scale were used to evaluate disease progression and its impact on quality of life. SCS system implantation is considered a safe procedure and cost-effective in the long term. The mechanisms behind these effects are still unknown, but SCS is a promising treatment option. More studies that include larger numbers of patients are needed. Key words: Buerger, tobacco, ischemia, amputation, electrical spinal cord stimulation, transcutaneous oxygen pressure