One-year follow-up for the therapeutic efficacy of pregabalin in patients with leg symptoms caused by lumbar spinal stenosis.

BACKGROUND: Pregabalin is a well-accepted treatment option for patients with neuropathic pain. However, the therapeutic efficacy of pregabalin for reducing the incidence of spinal surgery to treat leg symptoms in patients with lumbar spinal stenosis remains unknown. The purpose of this study was to analyze the therapeutic efficacy of pregabalin for reducing the incidence of spinal surgery for leg symptoms in patients with lumbar spinal stenosis during the first year of treatment. METHODS: Consecutive patients diagnosed with lumbar spinal stenosis at our hospital from January to June 2009 were treated with nonsteroidal anti-inflammatory drug monotherapy and formed the control group (n = 47; 22 males, 25 females). Patients diagnosed with lumbar spinal stenosis at our hospital between August 2010 and October 2011 were treated with a nonsteroidal anti-inflammatory drug and pregabalin combination therapy and formed the pregabalin group (n = 49; 27 males, 22 females). The proportions of patients who underwent spinal surgery during the first year of treatment were assessed and compared between the two groups using the Mann-Whitney U test. In addition, the periods in which patients decided to undergo spinal surgery were compared using the Kaplan-Meier method. RESULTS: Six patients (12.2%) in the pregabalin group and 22 patients (46.8%) in the control group underwent spinal surgery during the first year of treatment (P = 0.0035). The period in which patients decided to undergo spinal surgery was significantly delayed in the pregabalin group compared with the control group in those for whom spinal surgery was necessary (P = 0.0128). CONCLUSIONS: Nonsteroidal anti-inflammatory drug and pregabalin combination therapy may result in a lower incidence of spinal surgery during the first year of treatment or a delayed period before undergoing spinal surgery if necessary compared with nonsteroidal anti-inflammatory drug monotherapy in patients with leg symptoms caused by lumbar spinal stenosis.

Four-year follow-up of pregnancy-associated osteoporosis: a case report.

A 22-year-old woman presented with complaints of severe pain in a wide region of the thoracolumbar spine. She developed severe pain in the thoracolumbar spine region 2 months after her first delivery and was referred 1 month later. A lateral thoracic X-ray showed depressed degenerative vertebrae (T7, T9). One month after the initial examination, thoracic sagittal magnetic resonance imaging showed low intensity areas on T1-weighted imaging and iso-high intensity areas on T2-weighted imaging at T5, 7, 8, 9 and 11. Bone mineral density measured by ultrasound was low (%YAM 76%). The bone metabolic markers were high, suggesting accelerated osteoclast activity. These findings prompted a diagnosis of pregnancy-associated osteoporosis. She was asked to stop breastfeeding and to wear a lumbar brace, and treatment with nutritional calcium, activated vitamin D3, and risedronate sodium was started. Her low back pain almost disappeared after treatment. Bone metabolic markers showed normalization 8 months after the initial examination. Risedronate sodium was stopped 2 years and 2 months after the initial examination. Teriparatide treatment was started because her bone mineral density remained low; however, the osteoblast marker P1NP was not increased 5 months after the start of teriparatide treatment.

Therapeutic efficacy of pregabalin in patients with leg symptoms due to lumbar spinal stenosis.

The purpose of this study was to evaluate the therapeutic efficacy of pregabalin in patients with leg symptoms due to lumbar spinal stenosis. Study subjects were classified into two groups according to their pharmacotherapy: the pregabalin group, treated with nonsteroidal anti-inflammatory drug and pregabalin combination therapy, and the control group, treated with nonsteroidal anti-inflammatory drug monotherapy. The two groups were compared in terms of the duration of pain after the onset of leg symptoms and the type of neurogenic intermittent claudication, whether radicular-, caudal-, or mixed-type. Numerical rating scale and Roland-Morris Disability Questionnaire scores were evaluated before and 3 months after treatment. After 3 months of treatment, there were significant differences in the numerical rating scale for radicular- and mixed-types, but not for caudal-type, between the two groups in the subjects with leg symptoms for greater than 3 months. There were significant differences between the two groups in Roland-Morris Disability Questionnaire scores for mixed-type, but not for radicular- and caudal-types, in the subjects with leg symptoms for less than 3 months and for radicular- and mixed-types, but not for caudal-type, in the subjects with leg symptoms for greater than 3 months. Nonsteroidal anti-inflammatory drug and pregabalin combination therapy may be more effective than nonsteroidal anti-inflammatory drug monotherapy for the relief of leg symptoms due to lumbar spinal stenosis, preventing aggravation of subjective symptoms and improving quality of life for patients with radicular- and mixed-types in subjects with leg symptoms for greater than 3 months, although it may be necessary to consider alternative therapy for patients with caudal-type.