Lumbar spinal stenosis is a chronic, progressive disease with a poor prognosis, so most scholars advocate early surgical treatment, but not all patients with lumbar spinal stenosis need immediate surgical treatment. As Dr. Yu mentioned before, lumbar spinal stenosis is similar to coronary artery disease in that it is a degenerative aging of the human pipeline system, resulting in narrowing of the pipeline and thus clinical symptoms, and there is some scientific justification for the saying in Chinese medicine that “if it does not pass, it hurts”.
Lumbar spinal stenosis can be classified as mild, moderate or severe according to the clinical symptoms and the degree of compression on imaging, and in general, conservative treatment can be adopted for mild and moderate stenosis, while surgery should be considered for severe stenosis.
Can lumbar spinal stenosis be treated conservatively?
Conservative treatment is suitable for patients with mild to moderate spinal stenosis, and treatment measures include
(1) Bed rest: Bed rest improves local venous reflux, allows aseptic inflammatory response to subside, reduces pressure in the spinal canal, and relaxes the lumbar back muscles. Generally, the subjective symptoms will be reduced by 2 weeks of bed rest.
(2) Anti-inflammatory and analgesic drugs and blood circulation herbal treatment: Non-steroidal anti-inflammatory and analgesic drugs can reduce inflammation and relieve pain symptoms, and some blood circulation herbal medicines can also reduce patients’ clinical symptoms.
(3) Calcitonin treatment: Calcitonin can treat osteoporosis of the lumbar spine in elderly patients, and it is also effective for lumbar spinal stenosis.
(4) massage and physiotherapy: massage can accelerate blood circulation and reduce muscle spasm, but the technique must be gentle. Physiotherapy can eliminate local inflammation, release muscle spasm and relieve symptoms.
(5) Pelvic traction: It can pull apart the distance between the small joints and vertebrae of the lumbar spine to relieve the compressed nerves and reduce congestion and edema to achieve relief of clinical symptoms. If the discomfort increases after traction, it is appropriate to stop immediately.
(6) spinal core muscle group exercise: instability of the spine and lumbar back muscle strength, abdominal muscles, the degree of osteoporosis, lumbar back muscle, abdominal muscle exercise aims to strengthen the stability of the lumbar spine, which helps to slow down the rate of degenerative spinal degeneration.
(7) belt or brace protection: the purpose is to help strengthen the stability of the spine, the effect is better for slippage secondary to spinal stenosis, etc., the symptoms can be rapidly improved after use, but should not be used for a long time, long-term reliance on the brace can contribute to lumbar muscle atrophy.
(8) Epidural injection of corticosteroids in the lumbar spinal canal is suitable for cases of moderate spinal stenosis with poor results of other conservative treatments. It can reduce the edema and inflammation of the compressed nerve roots to a certain extent, thus partially relieving the clinical symptoms, but it cannot fundamentally eliminate the causes of symptoms, and intra-sacral closure requires strict aseptic operation, otherwise it is easy to cause serious complications of intra-vertebral canal infection, resulting in adverse consequences.
Not every patient needs to do all of the above conservative treatment programs. According to Dr. Yu’s clinical experience, (1), (2) and (6) are the more basic parts, while others need to choose the appropriate means according to the patient’s condition, with rest and symptomatic treatment being the main focus during the acute attack period, and strengthening exercise during the remission period.
Expert interpretation: lumbar spinal stenosis is a degenerative disease, the mechanism of conservative treatment is to reduce inflammation and improve neuroedema, but conservative treatment has its limitations, it can not solve the problem of stenosis and compression, so the factors causing nerve inflammation and ischemia will exist for a long time, so the symptoms can recur after improvement, and with the increase of age, stenosis and compression will gradually aggravate, conservative treatment is actually Conservative treatment is actually a reflection of the body’s ability to compensate, but this ability to compensate is limited, just like early coronary heart disease we can improve the symptoms through lifestyle changes and medication to dilate the blood vessels, but when the coronary artery stenosis reaches a certain level, it is necessary to consider stent placement or bypass surgery. Many people are afraid to operate when they are too old, which is actually a wrong view. The disease itself is a disease of the elderly, and secondly, surgery is generally more effective and early treatment is necessary to improve quality of life.
When do I need surgery for lumbar spinal stenosis?
Lumbar spinal stenosis is first treated conservatively, but surgery should be considered in the following cases
(1) If the symptoms and signs are severe and no significant effect is observed after more than three months of systematic conservative treatment;
(2) Those who show signs of damage to the cauda equina and have difficulty in urination and defecation;
(3) Progressive neurological symptoms with significant loss of muscle strength, muscle atrophy, etc;
(4) Lumbar spinal stenosis combined with lumbar instability or lumbar spondylolisthesis;
(5) localized significant stenosis with corresponding clinical symptoms confirmed by spinal canal imaging, CT or MRI.
Expert interpretation: Lumbar spinal stenosis is a chronic, progressive disease of the spinal cord and spinal nerve roots. Because it is chronic, it can be treated conservatively in the early stages, but because it is a progressive disease, once the stenosis reaches a certain level, conservative treatment cannot achieve good results and surgery is required. For those who have urinary and fecal dysfunction or progressive neurological symptoms such as obvious muscle strength loss and muscle atrophy due to compression of the cauda equina, early surgery should be performed to save the function of the nerve; for those who have poor results from conservative treatment, they should not drag or endure the disease; for those who have severe spinal stenosis or combined with lumbar spinal slippage, and who are expected to have poor results from conservative treatment, early surgery should also be performed.