Kazuo Nakanishi1, Masato Tanaka, Haruo Misawa, Tomoyuki Takigawa, Toshifumi Ozaki. 1. Department of Orthopaedic Surgery, Okayama University Hospital of Medicine and Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan. kazu17@md.okayama-u.ac.jp
Abstract
STUDY DESIGN: The midterm results of prostaglandin E1 (PGE1) treatment in patients with lumbar spinal canal stenosis, and discuss the factors influencing the improvement rate by using multivariable analysis. OBJECTIVE: We report the clinical results of PGE1 treatments in patients with lumbar spinal canal stenosis. SUMMARY OF BACKGROUND DATA: Neurogenic intermittent claudication, a prominent symptom of lumbar spinal canal stenosis, poses a substantial impairment of quality of life in patients. A variety of approaches to treatment for lumbar spinal canal stenosis have been reported. However, general systemic complications make it difficult for many elderly people to undergo surgical treatment. Sometimes the only reasonable option is to receive conservative treatment. METHODS: The subjects were 63 patients with lumbar spinal canal stenosis. After admission, patients were given an intravenous infusion of PGE1 (60 microg/d) for approximately 2 weeks. To obtain the spinal canal stenosis rate, the area of the dural canal observed on magnetic resonance imaging and CT myelography was measured by using image analysis software (NIH image). The correlation of improvement rates to ages, JOA scores, claudication distances, and stenosis rate obtained through magnetic resonance imaging was evaluated using multivariable analysis. RESULTS: Regardless of stenosis type, JOA scores significantly improved after PGE1 administration (the mixed type: P < 0.0001, the nerve root type: P < 0.01, and the cauda equina type: P < 0.01), and claudication distance was significantly improved. Multivariable analysis showed that JOA scores before PGE1 administration significantly contributed to the improvement rates. CONCLUSION: Our midterm results showed that PGE1 was useful for treating intermittent claudication in patients with lumbar spinal canal stenosis. The effect of PGE1 was not related to the degree of stenosis obtained with images, age, or claudication distance, but was correlated with baseline disease severity (JOA scores before administration).
STUDY DESIGN: The midterm results of prostaglandin E1 (PGE1) treatment in patients with lumbar spinal canal stenosis, and discuss the factors influencing the improvement rate by using multivariable analysis. OBJECTIVE: We report the clinical results of PGE1 treatments in patients with lumbar spinal canal stenosis. SUMMARY OF BACKGROUND DATA: Neurogenic intermittent claudication, a prominent symptom of lumbar spinal canal stenosis, poses a substantial impairment of quality of life in patients. A variety of approaches to treatment for lumbar spinal canal stenosis have been reported. However, general systemic complications make it difficult for many elderly people to undergo surgical treatment. Sometimes the only reasonable option is to receive conservative treatment. METHODS: The subjects were 63 patients with lumbar spinal canal stenosis. After admission, patients were given an intravenous infusion of PGE1 (60 microg/d) for approximately 2 weeks. To obtain the spinal canal stenosis rate, the area of the dural canal observed on magnetic resonance imaging and CT myelography was measured by using image analysis software (NIH image). The correlation of improvement rates to ages, JOA scores, claudication distances, and stenosis rate obtained through magnetic resonance imaging was evaluated using multivariable analysis. RESULTS:Regardless of stenosis type, JOA scores significantly improved after PGE1 administration (the mixed type: P < 0.0001, the nerve root type: P < 0.01, and the cauda equina type: P < 0.01), and claudication distance was significantly improved. Multivariable analysis showed that JOA scores before PGE1 administration significantly contributed to the improvement rates. CONCLUSION: Our midterm results showed that PGE1 was useful for treating intermittent claudication in patients with lumbar spinal canal stenosis. The effect of PGE1 was not related to the degree of stenosis obtained with images, age, or claudication distance, but was correlated with baseline disease severity (JOA scores before administration).