Lumbar spinal stenosis is a condition characterized by intermittent claudication as the main feature of back and leg pain due to abnormal spinal canal structure and narrowing of the spinal canal lumen caused by primary or secondary factors.
Symptoms
1.Symptoms of low back and leg pain
2. Intermittent claudication. It often produces low back and leg pain when walking one or two hundred meters, and the symptoms will be alleviated or disappear immediately after bending down and resting for a while or squatting, and if it continues to walk again, the pain will appear again soon. The symptoms are aggravated when the back is stretched backwards and reduced when bending over. In a few cases, the compression of the cauda equina and nerve roots affects the bowel and urine, and even causes incomplete paralysis of the lower limbs.
Diagnosis of lumbar spinal stenosis
Appropriate auxiliary examination methods, such as X-ray plain film, CT, MRI, etc., should be selected according to clinical manifestations to make accurate localization, qualitative and quantitative diagnosis.
Diagnostic points
1. Lumbar spinal stenosis is common in middle-aged people and above, more men than women
2. The main symptoms are long-term recurrent back and leg pain and intermittent claudication. The nature of the pain is soreness or burning pain, some of which may radiate to the outer thighs or the front, mostly bilaterally, and may alternate between the left and right legs. When standing and walking, lumbar and leg pain or numbness and weakness, pain and limp gradually worsen, even can not continue to walk, the symptoms improve after rest, riding a bicycle without hindrance.
3.In severe cases, it may cause urinary urgency or difficulty in urination.
CT and MRI examinations can help to make a clear diagnosis.
Treatment of lumbar spinal stenosis
Lumbar spinal stenosis is one of the conditions leading to chronic low back pain, and the treatment of this disease mainly includes conservative treatment and surgery.
The commonly used conservative treatments are
(1) Manipulation therapy: The purpose of manipulation therapy is to activate blood circulation and relax tendons, disperse blood stasis and loosen adhesions, so that symptoms can be relieved. Commonly used techniques are pressing and kneading, 扌扌法, 拿法, rubbing, rubbing and passive movement of lower limb flexion and extension.
(2) Acupuncture and moxibustion treatment: acupuncture points such as lumbar Yangguan, kidney Yu, large intestine Yu, Qihai Yu, vital gate, ring jump, Fengshui, Weizhong and Kunlun can be taken once a day, 10 times a course of treatment.
(3) Drug therapy: Analgesic and anti-inflammatory drugs such as fotarine and fenbid can be used for aseptic inflammation of nerve roots. Chinese medicine should be used to warm the meridians, strengthen the tendons and bones, can be used to supplement the kidney and strengthen the tendons soup plus reduction, commonly used drugs such as Shu Di, gun ginger, Du Zhong, cow knee, system dog spine, sequesters, etc.. If there is deficiency of qi and blood, add Astragalus, Radix Codonopsis, Radix Angelicae Sinensis and Radix Paeoniae Alba. For cold pain in the lower back and legs, add chicken blood vine, douhu, gui zhi, epimedium, etc.
(4) closed treatment: available epidural closure, can eliminate swelling, loosen adhesions, relieve symptoms, commonly used prednisolone acetate 12, 5mg plus 1% procaine 10ml, once a week.
(5) medical sports: can strengthen the back extension muscle, abdominal muscle muscle exercise, so that the stability of the lumbar vertebrae increased, thus delaying the rate of evolution of lumbar joint degeneration. Playing Taijiquan has a better effect on this disease.
(6) Surgery: If the above conservative treatment is ineffective or the effect is not obvious, surgery can be considered.
When is surgical treatment needed
(1) Back and leg pain after activity, affecting life and work, not cured by conservative treatment.
(2) Progressive claudication is aggravated, or standing time is gradually shortened.
(3) Those who have obvious deficiency of nerve function.
The purpose of surgery is to relieve the compression of nerve tissue and blood vessels in the spinal canal, nerve root canal or intervertebral foramen. The common surgical procedures are laminectomy and nerve root decompression.