title: Conservative and surgical treatment improves pain and ankle-brachial index in patients with lumbar spinal stenosis.
abstract: OBJECTIVE
  The pathological mechanism of lumbar spinal stenosis is reduced blood flow in nerve roots and degeneration of nerve roots. Exercise and prostaglandin E1 is used for patients with peripheral arterial disease to increase capillary flow around the main artery and improve symptoms; however, the ankle-brachial index (ABI), an estimation of blood flow in the main artery in the leg, does not change after treatment. Lumbar spinal nerve roots contain somatosensory, somatomotor, and unmyelinated autonomic nerves. Improved blood flow by medication with prostaglandin E1 and decompression surgery in these spinal nerve roots may improve the function of nerve fibers innervating muscle, capillary, and main vessels in the lower leg, resulting in an increased ABI. The purpose of the study was to examine whether these treatments can improve ABI.
  
  
  METHODS
  One hundred and seven patients who received conservative treatment such as exercise and medication (n=56) or surgical treatment (n=51) were included. Low back pain and leg pain scores, walking distance, and ABI were measured before treatment and after 3 months of conservative treatment alone or surgical treatment followed by conservative treatment.
  
  
  RESULTS
  Low back pain, leg pain, and walking distance significantly improved after both treatments (p<0.05). ABI significantly increased in each group (p<0.05).
  
  
  CONCLUSIONS
  This is the first investigation of changes in ABI after treatment in patients with lumbar spinal stenosis. Improvement of the spinal nerve roots by medication and decompression surgery may improve the supply of blood flow to the lower leg in patients with lumbar spinal stenosis.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. sohtori@faculty.chiba-u.jp
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohtori
authors.forename: Masaomi
authors.initials: M
authors.lastname: Yamashita
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Murata
authors.forename: Yawara
authors.initials: Y
authors.lastname: Eguchi
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Aoki
authors.forename: Hiromi
authors.initials: H
authors.lastname: Ataka
authors.forename: Jiro
authors.initials: J
authors.lastname: Hirayama
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ozawa
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Morinaga
authors.forename: Hajime
authors.initials: H
authors.lastname: Arai
authors.forename: Masaya
authors.initials: M
authors.lastname: Mimura
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kamoda
authors.forename: Sumihisa
authors.initials: S
authors.lastname: Orita
authors.forename: Masayuki
authors.initials: M
authors.lastname: Miyagi
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Miyashita
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sameda
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Eiji
authors.initials: E
authors.lastname: Hanaoka
authors.forename: Miyako
authors.initials: M
authors.lastname: Suzuki
authors.forename: Munetaka
authors.initials: M
authors.lastname: Suzuki
authors.forename: Takato
authors.initials: T
authors.lastname: Aihara
authors.forename: Toshinori
authors.initials: T
authors.lastname: Ito
authors.forename: Gen
authors.initials: G
authors.lastname: Inoue
authors.forename: Masatsune
authors.initials: M
authors.lastname: Yamagata
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Toyone
authors.forename: Gou
authors.initials: G
authors.lastname: Kubota
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakuma
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Oikawa
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Inage
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sainoh
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Yamauchi
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000527:Alprostadil / Q000627:therapeutic use; D055109:Ankle Brachial Index; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000601:surgery; D013126:Spinal Nerve Roots / Q000503:physiopathology; D013130:Spinal Stenosis / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000527:Alprostadil
keywords: Ankle-brachial index; lumbar; pain; spinal stenosis