When it comes to lumbar spinal stenosis, we must mention a word called “intermittent claudication”, which means that it is difficult to walk after walking a certain distance and often needs to stop and sit, stand or squat for a while in order to continue walking, and then after a certain distance, it needs to stop and rest again. This is the most typical feature of central spinal stenosis, which is the weakness of both lower limbs after walking, but can continue to walk after squatting or bending down to rest, and can still ride a bicycle. My summary of the mantra is: fear of walking and fear of standing can ride a bike, squatting and bending can relieve. Lumbar spinal stenosis is due to degenerative changes in the lumbar spine, caused by herniated discs, ligamentous hypertrophy, osteophytes and narrowing of the space where the nerves are located, compressing the nerves. It is like a water pipe with a lot of scale inside, the water does not flow smoothly, the spinal stenosis is because the nerves stay in a narrow tube, the nerve conduction current is not smooth, walking will not work, mostly seen in the middle-aged and elderly. Why is there no problem when riding a bicycle or bending over? This is because the volume of the spinal canal increases when bending over, partially relieving nerve compression. There is another type of lumbar spinal stenosis, which is a narrowing of the lateral canal, manifested as soreness, numbness, pain, and coldness in the lower limbs. The figure below shows that the lateral foramen of the lumbar spine is narrowed and also compresses the nerve, but the symptoms appear only on one side. Putting it all together, the clinical manifestations of lumbar spinal stenosis are: 1. Intermittent claudication: after the patient walks a certain distance, gradually increasing pain, numbness, heaviness, and weakness occur in the lower extremities, and the patient has to stop walking, squatting or sitting down to rest for a few moments after which the symptoms can be alleviated or disappear, and continuing to stand or walk, the symptoms reappear and he is forced to rest again. It is fine when riding a bicycle. 2.Lower back pain: the pain is usually mild, and is reduced or disappeared by bed rest. 3.Signs and symptoms of nerve root compression: soreness, numbness, swelling and scurrying pain in the buttocks and legs, with different degrees of pain. The pain varies from time to time. Prevention: 1. Prevention of spinal stenosis begins with good lifestyle habits, such as not sitting or keeping your head down for too long, etc. 2, do not sit or stand, or ambulate work for too long. 3, usually pay more attention to reasonable labor posture and good living habits. When lifting heavy objects, hip and knee bending squatting, when sleeping, the best position of the head and neck for the natural neutral position. Second, treatment: treatment of lumbar spinal stenosis mild can choose conservative treatment, mainly drugs to relieve symptoms, acupuncture and physical therapy, etc., in general, without surgery. For severe spinal stenosis, at this time, drugs cannot release the compression, and conservative treatment is ineffective, surgery is needed to expand the spinal canal and release the nerve compression. Third, traditional surgery: after getting lumbar spinal stenosis, conservative invalid, can be considered from the posterior open surgery. The main purpose is to decompress and expand the spinal canal. In case of poor spinal stability, internal fixation, i.e. “steel nails”, is needed to refix the spine. Minimally invasive treatment: Newer methods, such as intervertebral foraminoscopy, can achieve the above-mentioned open surgery through a small incision (6 mm). The advantage of this method is that local anesthesia is sufficient, the patient is awake, and it is suitable for elderly people who have problems with general anesthesia at an advanced age. There is less bleeding, quicker discharge (same day), and lower cost than open surgery. In terms of its limitations, one is that only anterior or posterior compression can be released, and a single approach cannot release 360 degrees of compression. Secondly, it requires very skilled masters to be able to operate as well, and the surgery is more difficult than for intervertebral disc herniation. For lateral stenosis, there are very good indications. For severe stenosis, whether it can be treated with minimally invasive treatment requires good communication and discussion between the physician patient.