Midterm results of prostaglandin E1 treatment in patients with lumbar spinal canal stenosis accompanied by intermittent claudication.
METHODS
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.


BACKGROUND
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.


CONCLUSIONS
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).
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
Kazuo
K
Nakanishi
Masato
M
Tanaka
Haruo
H
Misawa
Tomoyuki
T
Takigawa
Toshifumi
T
Ozaki
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000527:Alprostadil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007383:Intermittent Claudication / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009192:Myelography; D020127:Recovery of Function; D012720:Severity of Illness Index; D013130:Spinal Stenosis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000527:Alprostadil