Spinal cord stimulation (SCS) has been an emerging therapy for patients with intractable ischemic pain and non-healing diabetic foot complications. While traditionally used for pain relief, evidence is building that SCS may also enhance blood flow, support ulcer healing, and even prolong limb salvage. But the critical question remains: who benefits most from this expensive and invasive therapy?
A new study by Bao et al. (2025) published in the Journal of Tissue Viability sheds light on how infrared thermography (IRT)—a simple, non-invasive imaging technique—can help identify which patients are most likely to benefit from SCS .
The Study at a Glance
- Population: 33 patients with diabetic foot (66 lower limbs in total).
- Intervention: Permanent spinal cord stimulation implantation.
- Follow-up: 6 months.
- Key Measurements: Pre- and 1-week postoperative IRT (skin temperature), ulcer grading, and large-fiber neuropathy using the 10-g monofilament test.
Major Findings
- Limb Salvage Rate:
- Overall success (no amputation): 78.8%.
- Failures (amputation required): 21.2%.
- The Power of IRT:
- Patients with successful outcomes showed an average increase of +0.65°C in limb temperature postoperatively.
- Patients who failed treatment showed a decrease of –0.70°C.
- The diagnostic threshold was identified as –0.12°C:
- Patients with a temperature rise above this threshold were significantly more likely to achieve limb salvage.
- Neuropathy Matters:
- Patients with large-fiber neuropathy had much poorer outcomes (success rate 59.1%) compared with those without (88.6%).
- Ulcer Severity Did Not Predict Outcomes:
- Surprisingly, ulcer severity was not associated with SCS treatment success.
Why This Matters
The study highlights a practical perioperative test: measuring temperature changes with IRT during the first week of SCS implantation. This approach provides an early signal of whether the therapy is likely to succeed.
- If IRT rises ≥ –0.12°C: patients have a strong chance of limb salvage.
- If IRT falls below –0.12°C and neuropathy is present: caution is warranted before committing to long-term, costly SCS therapy.
This means clinicians may soon be able to better tailor therapy, sparing patients unnecessary procedures and reducing costs, while maximizing the benefit for those who stand to gain the most.
The Bigger Picture
Diabetic foot complications remain a leading cause of non-traumatic amputation worldwide, with devastating personal and societal costs. While advances in revascularization, wound care, and infection management continue, neuromodulation strategies like SCS may represent a valuable adjunct in selected patients.
Bao et al.’s findings point toward a future where precision medicine in diabetic foot care could rely not only on clinical examination and angiography, but also on real-time physiological markers like skin thermography.
Citation
Bao M, Qu H, Zhang M. “Spinal cord stimulation in patients with diabetic foot: Determining prognosis using infrared thermography.” Journal of Tissue Viability. 2025;34:100957. doi:10.1016/j.jtv.2025.100957
Leave a Reply