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
The role of epidural spinal cord stimulation in the treatment of Buerger’s disease