Granulocyte colony-stimulating factor reduced neuropathic pain associated with thoracic compression myelopathy: report of two cases

Abstract

Context: A clinical trial was conducted to evaluate the safety and efficacy of neuroprotective therapy using granulocyte colony-stimulating factor (G-CSF) for patients with worsening symptoms of compression myelopathy. During this trial, we found that neuropathic pain associated with thoracic myelopathy was dramatically reduced after G-CSF administration in two cases.

Findings: A 32-year-old man with compression of the spinal cord at levels T7-T10 complained of spastic gait associated with spontaneous severe pain from his back to his chest. G-CSF 10 µg/kg/day was administered for 5 consecutive days; his pain was reduced 1 day after the initial G-CSF administration. One month after administration, he underwent spinal fusion surgery for decompression of the spinal cord. Six months after G-CSF administration, he showed recovery from myelopathy and no recurrence of pain. A 68-year-old man with spastic gait and bilateral thigh pain caused by ossified ligamentum flavum at T11-T12 was treated with G-CSF 10 µg/kg/day for 5 days; his pain was reduced 1 day after initial administration. One month later, he underwent a T10-T12 laminectomy. Three months after G-CSF administration, his thigh pain began to attenuate. At 6 months after administration, he showed recovery from myelopathy, and his pain was still improved compared with that before administration.

Conclusion: G-CSF may have a therapeutic effect on spinal neuropathic pain.

Figure 1

Case 1: T2-weighted midsagittal magnetic resonance image (A) and CT myelogram midsagittal reconstruction plane (B) 4 years prior to this admission showing anterior compression of the spinal cord by postvertebral osseous spurs at T7–T10. CT myelogram midsagittal reconstruction plane (C) and axial planes at T7–T8 and T9–T10 (D) on admission showing re-growth of the osseous spurs that compressed the spinal cord anteriorly at T7–T8 and T9–T10 (C, D, arrows) and a newly developed ossified ligamentum flavum (OLF) that compressed the spinal cord posteriorly at T9–T10 (C, D, arrowheads).

Figure 2

Case 2: T2-weighted midsagittal magnetic resonance image (A) and CT midsagittal reconstruction plane (B) and CT axial plane at T11–T12 (C) showing posterior compression of the spinal cord by an OLF at T11–T12.