Definition
The current understanding of the etiology of lumbar spinal stenosis is relatively uniform. The definition that has been widely accepted clinically is that the lumbar spinal canal, nerve root canal, or intervertebral foramen has a congenital, developmental, or acquired bony or fibrous connective structure abnormality (degeneration, trauma, instability, and others) that causes cauda equina and nerve root symptoms due to a reduction in the internal diameter of one or more canal spaces in a single or multiple planes. This excludes simple disc herniation and occupational lesions such as infections and tumors.
Clinical manifestations
Intermittent claudication; lumbar pain and numbness in the lower extremities when standing upright or walking, pain and numbness are relieved in forward flexion; it is easy to go uphill and difficult to go downhill; lumbar and leg pain and numbness occur when the back is tilted back.
Conservative treatment
Applicable to mild lumbar spinal stenosis, with mild symptoms and less serious impact on life and work.
1.Bed rest: Applicable to the early stage of the disease. After bed rest, local venous reflux improves, sterile inflammatory reaction (congestion, edema) subsides, and the stenosis in the spinal canal is relieved, plus the relaxation of the lumbar back muscles.
2, anti-inflammatory and analgesic drug therapy: such as ibuprofen, diclofenac sodium, etc. can partially relieve the symptoms.
3, physical therapy: can eliminate inflammation, release muscle spasm, relieve symptoms.
4.Pelvic traction: can pull apart the inter-articular and intervertebral distance to relieve the compressed nerves, eliminate congestion and edema to relieve the symptoms.
5, lumbar back muscle exercise: the purpose is to strengthen the stability of the lumbar spine, help slow down the speed of spinal degeneration. Strong lumbar muscles are generally lighter clinical symptoms, and the number of episodes is reduced; exercise the lumbar back muscle after surgery can accelerate the recovery of lumbar function.
6, lumbar belt protection: the purpose is to strengthen the stability of the spine, the effect is better on the slip secondary to stenosis. The symptoms can be improved rapidly after use, but it should not be used for a long time, because long-term use can lead to lumbar muscle atrophy.
Surgical treatment
It is generally believed that the natural course of lumbar spinal stenosis is poor and should be treated surgically as soon as possible. The goal of surgical treatment is to adequately and effectively decompress the compressed cauda equina and nerve root tissue, such as spinal canal decompression, and to perform internal fixation and fusion at the same time.
Indications for surgery
1.Severe symptoms, after more than 3 months of systematic conservative treatment is obviously ineffective.
2.The nerve roots and cauda equina nerve are extensively damaged or paralyzed.
3.Lumbar disc herniation combined with lumbar spinal stenosis.
4.Spinal stenosis combined with lumbar spinal isthmus discontinuity and slippage.
5.Localized stenosis with corresponding clinical symptoms confirmed by spinal canal imaging, CT or MRI.