塩酸サルポグレラート（アンプラーグ®）が有効であった頚椎椎間板ヘルニアの2例

Cervical Disc Herniation Treated with 5-hydroxytryptamine-2 A Receptor Inhibitor (sarpogrelate). Case Reports

　症例は長期に非ステロイド性消炎鎮痛剤（NSAIDs）等を服用していたが治療効果の得られなかった，頚椎椎間板ヘルニアと診断された41歳と47歳のいずれも女性であった．セロトニン受容体拮抗薬である塩酸サルポグレラートを投与したところ急速に症状が改善した．近年，難治性の疼痛性疾患に対するセロトニン受容体拮抗薬に関する報告が散見されるようになった．一方で，椎間板ヘルニアにおいては髄核の脱出は神経根の炎症を誘発し，疼痛誘発物質であるセロトニンが神経痛を引き起こすとされている．従来の投薬で効果の得られない頚椎椎間板ヘルニアに対して，本剤の投与は考慮に値するものと思われた．

　Cases：Two females, 41 and 47 years old, were diagnosed as having cervical disc herniation on the basis of MRI findings. Despite prolonged treatment with NSAIDs and other medicines, their symptoms were not relieved. However, their symptoms began to subside rapidly after the start of treatment with sarpogrelate, a serotonin receptor antagonist. Discussion： In cases of disc herniation, it is known that prolapse of the nucleus pulposus induces not only mechanical compression of, but also inflammation in, the nerve root, causing neuralgia. Recently, reports on the effects of an oral serotonin receptor antagonist on spinal nerve diseases such as lumbar disc herniation and lumbar spinal canal stenosis have been published. Serotonin is thought to be closely involved in such nerve root inflammation. Sarpogrelate was also effective for the treatment of herniated discs of the cervical spine in our cases, and deserves to be tried when dealing with cases of cervical disc herniation resistant to other medicines.