• Seiji Ohtori, Masaomi Yamashita, Yasuaki Murata, Yawara Eguchi, Yasuchika Aoki, Hiromi Ataka, Jiro Hirayama, Tomoyuki Ozawa, Tatsuo Morinaga, Hajime Arai, Masaya Mimura, Hiroto Kamoda, Sumihisa Orita, Masayuki Miyagi, Tomohiro Miyashita, Yuzuru Okamoto, Tetsuhiro Ishikawa, Hiroaki Sameda, Tomoaki Kinoshita, Eiji Hanaoka, Miyako Suzuki, Munetaka Suzuki, Takato Aihara, Toshinori Ito, Gen Inoue, Masatsune Yamagata, Tomoaki Toyone, Gou Kubota, Yoshihiro Sakuma, Yasuhiro Oikawa, Kazuhide Inage, Takeshi Sainoh, Kazuyo Yamauchi, Kazuhisa Takahashi, and Chiba Low Back Pain Research Group.
• Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. sohtori@faculty.chiba-u.jp
• Yonsei Med. J. 2013 Jul 1; 54 (4): 999-1005.

PurposeThe pathological mechanism of lumbar spinal stenosis is reduced blood flow in nerve roots and degeneration of nerve roots. Exercise and prostaglandin E1 is used for patients with peripheral arterial disease to increase capillary flow around the main artery and improve symptoms; however, the ankle-brachial index (ABI), an estimation of blood flow in the main artery in the leg, does not change after treatment. Lumbar spinal nerve roots contain somatosensory, somatomotor, and unmyelinated autonomic nerves. Improved blood flow by medication with prostaglandin E1 and decompression surgery 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 whether these treatments can improve ABI.Materials And MethodsOne hundred and seven patients who received conservative treatment such as exercise and medication (n=56) or surgical treatment (n=51) were included. Low back pain and leg pain scores, walking distance, and ABI were measured before treatment and after 3 months of conservative treatment alone or surgical treatment followed by conservative treatment.ResultsLow back pain, leg pain, and walking distance significantly improved after both treatments (p<0.05). ABI significantly increased in each group (p<0.05).ConclusionThis is the first investigation of changes in ABI after treatment in patients with lumbar spinal stenosis. Improvement of the spinal nerve roots by medication and decompression surgery may improve the supply of blood flow to the lower leg in patients with lumbar spinal stenosis.

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