Steroids and L-Lysine Aescinate for Acute Radiculopathy Due to a Herniated Lumbar Disk

Abstract

Background and objectives: The efficacy of commonly prescribed analgesic and adjuvant drugs for the management of patients with radiculopathy has not been well established. Oral steroids are commonly used to treat sciatica or radiculopathy due to a herniated disk but the effect remains controversial. L-lysine aescinate showed superiority over placebo or baseline therapy with NSAIDs alone in treating sciatica, but have not been evaluated in an appropriately powered clinical trial.

Materials and methods: Randomized, double-blind clinical trial conducted in two health centers in collaboration with Uzhhorod Natioanl University in Ukraine. Adults (N = 90) with acute radicular pain and a herniated disk confirmed by MRI were eligible. Participants were randomly assigned to three groups (N = 30 in each) to receive a baseline therapy with lornoxicam (16 mg per day) and adjunctive 5-day course of IV dexamethasone (first group: 8 mg per day/40 mg total) or 0,1% solution of L-lysine aescinate (5 mL and 10 mL for group 2 and 3 respectively). Primary outcomes were Visual Analogue Scale changes and the straight leg raise angle at 15th and 30th day.

Results: The level of pain improvement at 15th days after initiation of therapy with dexamethasone or solution of L-lysine aescinate at doses of 5 or 10 mL was not significantly different. The lowest levels of pain were achieved in patients who received the L-lysine aescinate 10 mL, but the range of decrease in pain was slightly greater in the group administered dexamethasone.

Conclusions: Among patients with acute radiculopathy due to a herniated lumbar disk a short course of IV dexamethasone or L-lysine aescinate resulted in pain improvement at 15th and 30th day. Dexamethasone may be preferable if a longer-term analgesic effect is needed. Taking into account side effects of dexamethasone, a solution of L-lysine aescinate can be used to relieve pain symptoms.

Keywords: L-lysine aescinate; discogenic radiculopathy; glucocorticoids; sciatica; therapy.

Figure 1

The dynamics of the patient outcome by the Visual Analog Scale. Vertical coordinates correspond to the VAS, the flow width is proportional to the number of patients.

Figure 2

The dynamic of the Visual Analog Scale evaluated on the 1st, 15th, and 30th days of the study.

Figure 3

Dynamics of the patients of the three groups in a degree of the symptom of straight leg test. Vertical coordinates correspond to the assessment of the straight leg test, a number (90 indicates a negative symptom of straight leg test) of patients with an initial negative symptom of straight leg test are excluded from the analysis, the width of the streams is proportional to the number of patients.

Figure 4

The dynamic of the straight leg raise angle on the 1st, 15th, and 30th days of the study.

Figure 5

Quantum–quantile normal graph of residues of a mixed regression model, evaluated by degree of the straight leg test.

Figure 6

MRI of the lumbar spine images show a large extruded disc fragment at the L5-S1 level. Neuroimaging for 15 and 30 days does not indicate changes of the size of extrusion.

Figure 7

Initial T2-weighted MRI of the lumbar spine shows a large extruded disc at the L4-L5 level and the follow-up imaging shows up migrating fragment.

Figure 8

On follow-up T1 and T2-weighted MRI of the lumbar spine, the regressed extruded disc fragment is seen at the L2-3 level and the dural sac is free from compression.