Phosphodiesterase 5 Inhibitor Use in Patients Undergoing Decompression Surgery for Lumbar Spinal Stenosis.

Objective Our objectives were to explore the association between phosphodiesterase 5 inhibitor (PDE5i) use and lumbar decompression surgery (LDS) by evaluating the prevalence of LDS in a treatment group of patients with lumbar spinal stenosis (LSS) compared to a control group. Design We performed database review and extracted data including LDS prevalence, PDE5i dosage and fill dates. Treatment group was defined as those with PDE5i fill dates less than 30 days prior to surgery, and control group was defined as those with PDE5i fill dates at any other time. LDS prevalence rates for both groups were calculated. Results Our study found 599 LSS patients who were prescribed PDE5i. 338 underwent LDS. Of these, 71 (21%) filled their prescription less than 30 days prior to surgery, while 267 (79%) filled their prescription during a different time period. The majority (94.6%) of surgical patients received decompression at 2-or-more spinal levels. Conclusion Prevalence of LDS for LSS was significantly lower in patients in the treatment group on PDE5i therapy compared to the control group. Among many potential explanations, the vasodilatory effect of PDE5i may have contributed to a lower surgical rate. This is the first study to explore this novel association. Future prospective studies are necessary to better define the utility of PDE5i in LSS.