Limaprost, a prostaglandin E1 analog, improves pain and ABI in patients with lumbar spinal stenosis

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Purpose: Compression of the spinal nerve roots by lumbar spinal stenosis is a major clinical problem associated with intermittent claudication, pain and numbness. The pathological mechanism is reduced blood flow in nerve roots and degeneration of nerve roots. Prostaglandin E1 (PGE1) is used for patients with peripheral arterial disease (PAD) to increase capillary flow around the main artery and improve symptoms; however, the ankle-brachial index (ABI) does not change after treatment. Lumbar spinal nerve roots contain somatosensory, somatomotor, and unmyelinated autonomic nerves, and improved blood flow 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 the hypothesis that limaprost, a PGE1 analog, improves blood flow in compressed and degenerated spinal nerve roots, leading to improved function of sympathetic and parasympathetic nerves in spinal nerve roots innervating the lower leg and a resultant increase in the ABI.Methods: Limaprost (15 μg 3 times a day for 3 months) was administered orally to 49 patients with lumbar spinal stenosis. Low back pain and leg pain scores, walking distance, and ABI were measured before treatment and after 3 months of limaprost treatment.Results: Low back pain, leg pain, and maximum walking distance significantly improved after limaprost treatment (P<0.05). ABI was also significantly increased by limaprost treatment (P=0.003).Conclusions: This is the first investigation of changes in ABI in patients with lumbar spinal stenosis after treatment with a PGE1 analog. Our findings suggest that it is important to consider the role of the autonomic nervous system in spinal nerve roots associated with blood supply to the lower leg in patients with lumbar spinal stenosis.

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