Changes in Epidural Pressure During Walking in Patients With Lumbar Spinal Stenosis

Takahashi, Keisuke; Kagechika, Kenji; Takino, Tetsuya; Matsui, Takashi; Miyazaki, Toshiaki; Shima, Iwao

doi:10.1097/00007632-199512150-00017

Cited by 134 publications

(78 citation statements)

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“…An experiment performed by Olmarker demonstrated that the capillaries and venules of the nerve root could be occluded by mild compression of around 30-40 mmHg [30] . Takahashi et al [51] found that the epidural pressure is only 15 to 18 mmHg during lumbar flexion in LCS patients, but reaches 80 to 100 mmHg during lumbar extension. The epidural pressure increases with walking and the patient then stops walking because of leg pain and/or NIC.…”

Section: Effect Of Prostaglandin-e1 To Normal Nerve Root and Compressmentioning

confidence: 98%

Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis

Kobayashi

2014

WJO

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Spinal nerve roots have a peculiar structure, different from the arrangements in the peripheral nerve. The nerve roots are devoid of lymphatic vessels but are immersed in the cerebrospinal fluid (CSF) within the subarachnoid space. The blood supply of nerve roots depends on the blood flow from both peripheral direction (ascending) and the spinal cord direction (descending). There is no hypovascular region in the nerve root, although there exists a so-called water-shed of the bloodstream in the radicular artery itself. Increased mechanical compression promotes the disturbance of CSF flow, circulatory disturbance starting from the venous congestion and intraradicular edema formation resulting from the breakdown of the blood-nerve barrier. Although this edema may diffuse into CSF when the subarachnoid space is preserved, the endoneurial fluid pressure may increase when the area is closed by increased compression. On the other hand, the nerve root tissue has already degenerated under the compression and the numerous macrophages releasing various chemical mediators, aggravating radicular symptoms that appear in the area of Wallerian degeneration. Prostaglandin E1 (PGE1) is a potent vasodilator as well as an inhibitor of platelet aggregation and has therefore attracted interest as a therapeutic drug for lumbar canal stenosis. However, investigations in the clinical setting have shown that PGE1 is effective in some patients but not in others, although the reason for this is unclear.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Lumbar canal stenosis; Cauda equine; Nerve root; Prostaglandin E1; Blood flow Core tip: The radicular symptoms associated with degenerative disease of the lumbar spine are reported to be attributable to a combination of mechanical nerve root compression and resultant circulatory disturbance. Disturbance of blood flow in the cauda equina and nerve roots is reported to play an important role in the mechanism of intermittent claudication in patients with lumbar canal stenosis. Prostaglandin E1 (PGE1) is a potent vasodilator as well as an inhibitor of platelet aggregation and has therefore attracted interest as a therapeutic drug for lumbar canal stenosis with intermittent claudication. However, investigations in the clinical setting have shown that lipo-PGE1 is effective in some patients but not in others, although the reason for this is unclear.Kobayashi S. Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis. World

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Section: Effect Of Prostaglandin-e1 To Normal Nerve Root and Compressmentioning

confidence: 98%

Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis

Kobayashi

2014

WJO

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“…A number of authors reported a decrease of the axial spinal canal area as well as intervertebral foramen in lumbar extension due to bulging of the disc and thickening of the ligament flavum in both in vitro and in vivo studies [3,4,8]. Takahashi et al [15,16] reported the importance of increased epidural pressure in provoking neurological symptoms in LSS. According to their report, the epidural pressure at the stenotic level in patients with LSS was changeable with posture.…”

Section: Introductionmentioning

confidence: 99%

Development of percutaneously insertable/removable interspinous process spacer for treatment of posture-dependent lumbar spinal-canal stenosis: preclinical feasibility study using porcine model

et al. 2011

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Purpose A procedure using an interspinous process spacer (IPS) was recently developed for the treatment of posture-dependent lumbar spinal-canal stenosis (LSS) patients. We developed a novel IPS which can be inserted with simpler procedures and removed percutaneously. The objectives of this study were: (1) to evaluate the feasibility and safety of this novel technique, and (2) to assess the effectiveness of this spacer in terms of preventing an increase of epidural pressure in lumbar extension using a porcine model. Methods Eight young pigs were used. Under general anesthesia and image guidance, the spacers were inserted. Three months after operation, MR images were taken and all spacers were removed. Blood samples were obtained before and 1, 3, 7 days after surgery. After killing the animals, the lumbar spines were observed macroscopically. Another six animals were used. Under general anesthesia and image guidance, a flexible pressure transducer was inserted into the epidural space and epidural pressure was measured in neutral and at maximum extension with and without spacer insertion. Results Percutaneous insertion and removal of the spacer was successful for all animals through small skin incisions. MR images showed minimal damage to the muscle.No significant up-regulation of Interleukin-6 (IL-6) and CRP was detected. Macroscopic observation of the lumbar spine 3 months after the operation revealed that the area of the interspinous process contacting with the inserted spacer showed some bone erosion/remodeling. Insertion of the spacer did not affect the epidural pressure in neutral but significantly prevented an increase of epidural pressure in lumber extension. Conclusions This study demonstrated that the percutaneous insertion and removal of a novel IPS was feasible and safe using a simple technique. Furthermore, this procedure can be recognized as minimally invasive surgery from the viewpoint of skin incision, short insertion track, inflammatory mediators, and muscle damage. Improvements should be attempted in future studies using softer or more elastic materials for the spacer to lessen bone erosion/ remodeling at contacting area of the inserted spacer.

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“…24 It is thought that narrowing of the spinal canal results from degenerative changes of the spine, leading to compression or ischemia of the lumbosacral nerve roots. 22,25,26 In contrast, radicular pain (e.g., sciatica) is thought to be due to nerve root irritation from chemical or mechanical inflammation or from direct neural compression in the central canal. 27,28 Lumbar flexion does not improve radiculopathy, and the symptoms do not always occur independently but rather can be mixed.…”

Section: Resultsmentioning

confidence: 99%

Neuropathic Pain Components in Patients with Lumbar Spinal Stenosis

Park¹,

Hong

2013

The Spine Journal

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Changes in Epidural Pressure During Walking in Patients With Lumbar Spinal Stenosis

Cited by 134 publications

References 0 publications

Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis

Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis

Development of percutaneously insertable/removable interspinous process spacer for treatment of posture-dependent lumbar spinal-canal stenosis: preclinical feasibility study using porcine model

Neuropathic Pain Components in Patients with Lumbar Spinal Stenosis

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