New Hope for Diabetic Foot Treatment – Spinal Cord Electrical Stimulation

  According to the World Health Organization (WHO), diabetic foot is defined as an infection, ulcer formation and/or deep tissue destruction in the lower extremity of diabetic patients due to combined neuropathy and various degrees of peripheral vasculopathy. The diabetic foot mainly involves small arteries or micro-arteries, and the vasodilating drugs currently used have limited effect, and the commonly used revascularization and endovascular stenting are basically not applicable. As the disease progresses, the limb is eventually amputated, and postoperative healing is difficult, and some limbs are even amputated several times in a short period of time, causing great physical and mental pain to the patient.  Spinal Cord Stimulation (SCS), by stimulating the spinal cord area innervating the ischemic limb, on the one hand, inhibits sympathetic efferent impulses and dilates small arteries and micro-arteries in the ischemic area, while promoting the regeneration of capillaries and the establishment of collateral circulation in the ischemic area, thus effectively improving ischemia and promoting tissue healing and delaying amputation; on the other hand. On the other hand, by stimulating the thick afferent nerve fibers, it can close the pain gate and effectively relieve the pain of the ischemic limb.  It has been widely reported in the literature that SCS can achieve good results in severe ischemic ulcers caused by scleroderma, diabetes, thrombotic vasculitis, Raynaud’s syndrome, etc., although other conservative treatments and sympathectomy are ineffective, and even surgical reconstruction methods are not effective. In Europe, nearly 10,000 patients are treated with SCS every year, which has greatly reduced the rate of amputation, and SCS has given new hope to many diabetic foot patients.  In China, this treatment has just started, and only a few hospitals are offering it. The prognosis is very good for patients with ulcers or necrotic areas <3 cm squared or with a >15% increase in transcutaneous partial pressure of oxygen after test stimulation. SCS can relieve pain and delay amputation, but it does not change the final prognosis due to the progression of the disease itself.