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Limaprost alfadex and nonsteroidal anti-inflammatory drugs for sciatica due to lumbar spinal stenosis

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Abstract

Purpose

Limaprost, a prostaglandin E1 analog, has vasodilatory properties and increases blood flow of the nerve root. However, it has not been clarified whether limaprost affects pain sensation associated with radiculopathy due to lumbar spinal stenosis (LSS). The aim of this study was to compare the efficacy of oral limaprost with nonsteroidal anti-inflammatory drugs (NSAIDs) for radiculopathy.

Methods

We performed a multicenter prospective randomized trial. Patients with LSS who had radicular-type neurologic intermittent claudication assessed based on a self-reported diagnostic support tool were randomized into three treatment groups. Limaprost, NSAIDs, or limaprost plus NSAIDs were administered orally for 6 weeks. Leg pain, low back pain (LBP) and the associated symptoms were assessed by a numerical rating scale (NRS) both at rest and on movement as well as the Roland–Morris Disability Questionnaire (RDQ) and Short Form (SF)-36.

Results

Sixty-one patients were enrolled in the study. Each treatment finally reduced radicular pain, and the improvement was prominent in a combination treatment. There were no significant differences in radicular pain among three groups at final follow-up. LBP was not influenced by limaprost, and a significant reduction of LBP and RDQ was confirmed in a combination treatment compared with limaprost. Physical function of the SF-36 subscales after a combination treatment showed a marked alleviation compared with NSAIDs.

Conclusions

These obtained findings suggest that the effects of limaprost seem to be limited to radicular pain, not for LBP. Overall, a combination treatment might be more effective in the management of radiculopathy induced by LSS than monotherapy with either agent.

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Acknowledgments

The authors gratefully acknowledge medical staffs in 12 affiliated hospitals (Sukagawa hospital, Fukushima prefectural Aizu general hospital, Minamisoma municipal general hospital, Iwaki municipal kyouritsu hospital, Futaba kosei hospital, Fukushima prefectural Minamiaizu hospital, Fukushima prefectural Ono hospital, Shirakawa kosei general hospital, Fukushima red cross hospital, Ohara general hospital, Iwase general hospital, and Fukushima medical university hospital) and 1 private clinic (Ichiro orthopaedic clinic) that participated in the study.

Conflict of interest

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, School of Medicine, Fukushima Medical University, Fukushima, Fukushima, Japan

    Akira Onda, Shin-ichi Kikuchi, Shoji Yabuki, Koji Otani, Takuya Nikaido, Kazuyuki Watanabe & Shin-ichi Konno

  2. Department of Orthopaedic Surgery, Zensyukai Hospital, 1381-Ninomiya-cho, Maebashi, Gunma, 379-2117, Japan

    Akira Onda

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  1. Akira Onda
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  2. Shin-ichi Kikuchi
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  3. Shoji Yabuki
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  6. Kazuyuki Watanabe
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  7. Shin-ichi Konno
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Correspondence to Akira Onda.

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Onda, A., Kikuchi, Si., Yabuki, S. et al. Limaprost alfadex and nonsteroidal anti-inflammatory drugs for sciatica due to lumbar spinal stenosis. Eur Spine J 22, 794–801 (2013). https://doi.org/10.1007/s00586-012-2551-1

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  • DOI: https://doi.org/10.1007/s00586-012-2551-1

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