title: Prostaglandin E1 Treatment for Lumbar Spinal Canal Stenosis: Review of the Literature.
abstract: BACKGROUND
  The important pathophysiologic factor of neurogenic intermittent claudication (NIC) in lumbar spinal canal stenosis (LSCS) has been reported to be the reduction in intraneural blood flow and a state of relative ischemia in nerve tissues. Prostaglandin E1 (PGE1) presumably improves symptoms in patients with LSCS by improving the blood flow in the cauda equina and nerve roots through its vasodilation and antiplatelet aggregation effects. The purpose of the study was to summarize the results of previous studies regarding PGE1 treatment for LSCS and to describe the details of PGE1 treatment to all physicians who take care of patients with LSCS.
  
  
  METHODS
  Review of the literature.
  
  
  RESULTS
  There are 3 PGE1-related products that have been used clinically for the treatment of LSCS: PGE1, lipo-PGE1, and limaprost (PGE1 derivative). Experimental studies have been performed to verify the efficacy of PGE1 treatment for LSCS. Many studies have reported clinical outcomes of PGE1 treatment in patients with LSCS. Overall, previous studies examining PGE1 treatment for LSCS demonstrate improvement in several clinical outcome measures such as the visual analog scale, Japanese Orthopaedic Association score, and NIC distance, although most of the studies have only short-term follow-up.
  
  
  CONCLUSIONS
  Based on the results of previous studies, PGE1 treatment may be an option as a conservative treatment for LSCS. However, future studies with high-quality and long-term follow-up are necessary. Future studies also should include refinement of indications, administration period, as well as comparisons between PGE1 treatment and other conservative treatments such as epidural injection.
authors.affiliation: Department of Orthopaedic Surgery & Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A.|Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan.|Department of Orthopaedic Surgery, Nassau University Medical Center, Nassau, New York, U.S.A.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshihara
mesh_terms: D000328:Adult; D000368:Aged; D000527:Alprostadil / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D013130:Spinal Stenosis / Q000150:complications / Q000188:drug therapy*; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D000527:Alprostadil; C059238:limaprost
keywords: clinical outcome; lumbar spinal canal stenosis; neurogenic intermittent claudication; prostaglandin E1; treatment