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

Buerger’s disease (BD) or thromboangeitis obliterantsis a nonatherosclerotic segmental inflammationof the medium- and small-size arteriesand vessels of the extremities. The pathogenesisof this process remains unclear. This disease istypically seen in male smokers under 45 yearsof age, and successful therapy is possible onlywith abstinence from tobacco. Methods to controlischemic pain include nonpharmacological andpharmacological options, such as prostanoids, orsurgical intervention (sympathectomy or revascularization).This case report describes an unusualcase of Buerger’s disease in a 60-year-oldwoman with a moderate smoking habit. Despiteapparent tobacco abstinence and therapeuticoptimization, there was no clinical improvementin this patient with pharmacological treatment.Attending to the imminent risk of amputation ofher fingers, spinal cord stimulation (SCS) systemimplantation was the chosen therapeutic option.Transcutaneous oxygen pressure (TcPO2) wasmeasured at different points in time after implantationand there was a significant increment ofTcPO2 in both hands. In fact, the patient reportedno pain after the first month of spinal stimulation;analgesics were progressively reduced and completehealing of ulcers was achieved. Furthermore,the patient reported a substantial improvementin her quality of life and total functional recoveryin her hands mobilization after 6 months of treatment.The Brief Pain Inventory Scale and EuroQol-5D scale were used to evaluate disease progressionand its impact on quality of life. SCS systemimplantation is considered a safe procedure andcost-effective in the long term. The mechanismsbehind these effects are still unknown, but SCSis a promising treatment option. More studies thatinclude larger numbers of patients are needed.Key words: Buerger, tobacco, ischemia, amputation,electrical spinal cord stimulation, transcutaneousoxygen pressure