Short-Term Efficacy Analysis of Spinal Cord Stimulation in the Treatment of Refractory Diabetic Foot Ulcers: A Retrospective Study of 57 Cases

Category: Diabetes; Other Introduction/Purpose: This is the first study on the application of short-term spinal cord electrical stimulation for refactory diabetic foot ulcers. The purpose of this study is to evaluate its therapeutic effectiveness and update the comprehensive diagnosis and treatment process for diabetic foot ulcers based on existing therapeutic methods. Methods: Clinical data from 57 patients who underwent spinal cord electrical stimulation at our institution between May 2022 and November 2023 were retrospectively analyzed. The procedure involved the placement of temporary needle-like electrodes in the epidural space at the T10-T12 level using a puncture sheath. The electrical current is administered with a magnitude of 2.5-4.5 mA, a frequency of 50 Hz, and a pulse width of 240-300 μs, with a placement duration of 2 weeks. Patient demographics were recorded, with assessments of pain visual analog scale scores and foot temperatures conducted at pre-operation, postoperative day 3, postoperative 2 weeks, and postoperative 3 months. EuroQol- visual analog scale scores, Pittsburgh Sleep Quality Index, Ankle-Brachial Index, Semmes-Seinstein monofilament test, and ulcer area were recorded at pre-operation and postoperative 2 weeks. Repeated measures analysis of variance was employed to compare data differences at different time points, with P < 0.05 considered statistically significant. Results: The patients' pain visual analog scale scores decreased from 7.23 preoperatively to 3.64 at postoperative day 3, 2.89 at 2 weeks, with a slight increase to 5.84 at 3 months postoperatively (P < 0.05). Foot temperature increased from 30.19°C to 30.86°C at postoperative day 3, reaching 31.40°C at 2 weeks, and then decreased to preoperative levels at 3 months postoperatively (P < 0.05). At the 2-week postoperative assessment, there was a statistically significant improvement in EuroQol-Visual Analog Scale scores (77.91 from 66.70), PSQI (8.30 from 14.71), ABI (0.71 from 0.57), Semmes-Seinstein monofilament test (6.38 from 5.32), and ulcer area (11.36 cm² from 13.95 cm²). At 3 months postoperatively, there was no recurrence trend in ulcer area, and no patients required amputation due to disease progression. Conclusion: Short-term spinal cord electrical stimulation modulates vascular smooth muscle in the lower limbs, triggering vasodilation and thereby improving blood circulation to the lower extremities. Simultaneously, it mitigates clinical symptoms associated with diabetic foot ulcers by reducing peripheral nerve degeneration and blocking pain conduction. This dual effect significantly promotes the healing of ulcers in patients, greatly improving their quality of life. These findings provide a theoretical basis for the clinical application of long-term electrodes.