Prostaglandin E<sub>1</sub> Treatment for Lumbar Spinal Canal Stenosis: Review of the Literature

Yoshihara, Hiroyuki

doi:10.1111/papr.12272

Cited by 18 publications

(19 citation statements)

References 33 publications

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“…A recent review concluded that overall prostaglandin E1 improved clinical outcome measures including pain, Japanese Orthopedic Association score, and walking distance, although most of the studies had only short term follow-up. 98 Finally, although both corticosteroids and antidepressants are often prescribed for patients with LSS, their efficacy remains unclear because of the lack of well controlled studies.…”

Section: Natural Course Of Lssmentioning

confidence: 99%

Management of lumbar spinal stenosis

Lurie¹,

Tomkins-Lane

2016

BMJ

388

310

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Lumbar spinal stenosis (LSS) affects more than 200,000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency. Clinical care and research into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standard criteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in older people who are completely asymptomatic. The options for non-surgical management include drugs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation. However, few high quality randomized trials have looked at conservative management. A systematic review concluded that there is insufficient evidence to recommend any specific type of non-surgical treatment. Several different surgical procedures are used to treat patients who do not improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax and wane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality.

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Section: Natural Course Of Lssmentioning

confidence: 99%

Management of lumbar spinal stenosis

Lurie¹,

Tomkins-Lane

2016

BMJ

388

310

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“…Limaprost (Prostaglandin E 1 derivatives) improves symptoms in patients with lumbar spinal stenosis by improving the blood flow via its vasodilatory and antiplatelet aggregation effects (7). Ginkgo also inhibits plateletactivating factors and several studies showed that ginkgo increases the microcirculatory perfusion of blood vessels (8).…”

Section: Discussionmentioning

confidence: 99%

Scoliosis associated with idiopathic lumbosacral epidural lipomatosis

Han¹

2016

J. Spine Surg.

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There are very few reports of spinal epidural lipomatosis (SEL) in association with scoliosis. A 49-year-old man presented with persistent back pain and right hip lump. The lumbar spine X-rays showed scoliosis (Lenke classification 5BN). Lumbar MRI demonstrated circumferential epidural fat deposit from L1 to lower S2 level. There was no obvious etiology of SEL except mild increased body mass index (BMI). The patient was managed with conservative treatment. After 6 months medication (limaprost and ginkgo), his symptoms were relieved.

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“…Prostaglandin E1 derivative-related treatment of spinal stenosis include PGE1, liposomal prostaglandin E1 (lipo-PGE1), and limaprost. 1,2 The mechanism by which PGE1 derivatives treat spinal stenosis is a known increase in intraneural blood flow on compressed cauda equina or spinal nerve roots. 1 Specifically, lipo-PGE1 agonist is a PGE1 derivative that is incorporated into lipid microspheres and has a long duration of action.…”

mentioning

confidence: 99%

“…1,2 The mechanism by which PGE1 derivatives treat spinal stenosis is a known increase in intraneural blood flow on compressed cauda equina or spinal nerve roots. 1 Specifically, lipo-PGE1 agonist is a PGE1 derivative that is incorporated into lipid microspheres and has a long duration of action. 3 Moreover, it has a tendency to accumulate efficiently at sites of inflammation or vascular lesions; and thus, small doses of lipo-PGE1 enhance beneficial effects while alleviating adverse effects associated with large doses of PGE1 (hypotension, diarrhea, and phlebitis on injection site).…”

mentioning

confidence: 99%

“…4,5 Both preclinical and clinical studies have shown that intravenous lipo-PGE1 agonist is therapeutic in spinal stenosis. 1,5 If given epidurally, its effects would be relatively immediate and its effective dosage significantly lowered when compared to oral administration or parenteral injection. However, information on the applicability of epidural injection for many drugs is limited or absent, and requires further investigation.…”

mentioning

confidence: 99%

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