Non-surgical treatment is the mainstay of light and early cases of lumbar spinal stenosis, while surgery is required to enlarge the spinal canal if it is not effective.
I. Non-surgical treatment of lumbar spinal stenosis.
1.Traditional non-surgical treatment.
(1) Back muscle and abdominal muscle exercise: to increase the stability of the spine.
(2) Lumbar protection: including the external use of lumbar circumference, avoiding trauma and strenuous exercise, etc.
(3) symptomatic treatment: physiotherapy, external application of drugs, etc.
2, drug therapy: there are no special drugs, to activate blood circulation and neurotrophic drugs, including vitamins, Miaona, Salvia and Micronutrients, etc., can be used as appropriate.
Second, the lumbar spinal stenosis of the surgical treatment.
Surgical case selection.
1.Non-surgical treatment is ineffective: most of the cases in this group are secondary lumbar spinal stenosis.
2.Frequent attackers: all cases with frequent attacks that affect work and daily life.
3. Those with more obvious radicular symptoms: early surgery is recommended to avoid secondary arachnoid adhesions.
Clinically, the more commonly used surgical procedures and their choices are
1, due to hypertrophy of the ligamentum flavum: ligamentotomy alone can be performed.
2, general bony spinal stenosis: for severe symptoms, enlarged decompression of the spinal canal should be performed.
3.In cases of lateral saphenous stenosis: after confirming the compressed nerve root, take an enlarged open window or half-plate approach to enlarge the nerve root canal until the nerve root is fully relaxed.
4.Simple small joint variation and hypertrophy: the bone protruding into the spinal canal should be removed.
5, combined with intervertebral disc protrusion (prolapse): should be removed together in the operation.
6, with vertebral instability: feasible intervertebral fusion or pedicle nail fixation, or both.
Indications for surgery.
1.Developmental lumbar spinal stenosis: the diagnosis is clear, and the treatment by non-surgical therapy is ineffective.
2.Secondary lumbar spinal stenosis: the spinal canal is enlarged and decompressed while the primary disease is treated.
3.Other: for lumbar spinal stenosis combined with lumbar disc prolapse and lumbar spinal canal tumor, etc., simultaneous surgery can be performed.
Anesthesia and position: general anesthesia is mostly used, or other anesthesia, prone position is more convenient.
Surgical style.
1, incision: generally located in the lumbar 4 to sacral 1 segment, so the incision range is mostly taken in the middle of the segment longitudinal incision.
2.Postoperative treatment: after the operation, the incision should be flushed and the bleeding should be stopped thoroughly. The exposed dural sac and nerve roots should be covered with thin sheet of fat and negative pressure drainage tube should be placed to reduce adhesions. During the recovery period, in addition to general precautions, the lumbar back and abdominal muscles should be strengthened and trauma should be prevented.
Treatment of recurrent and severe lumbar spinal stenosis
In most of these severe cases, on the basis of congenital developmental spinal stenosis, the spinal stenosis is aggravated by many predisposing factors and various surgeries are performed, including total laminectomy decompression, segmental spinal decompression, lumbar spinal canal opening, etc. In a few cases, the spinal canal has been operated several times, and if the decompression is not complete, the condition may be aggravated by postoperative trauma and treatment has to be continued, including re-operation. However, such cases must be clearly understood comprehensively, especially the pathologic and anatomical status should be carefully analyzed and the main factors causing the current status should be identified before further treatment.
Recurrence factors.
There are many causes of recurrence of the disease, among which the following are the main categories.
1, the initial surgery decompression range is not enough: the most common, mainly the length or width of the vertebral segment decompression is not enough.
2, neglect of other lesions: the intervertebral disc in front of the spinal canal (protrusion, prolapse, etc.), the lateral small joint deformity, etc. failed to deal with at the same time.
3, postoperative hematoma formation: not only causes neurological compression symptoms, but also the scar formed after hematoma mechanization constitutes a new fiber canal stenosis.
4.Postoperative vertebral joint instability: If too many posterior lumbar structures are removed during surgery and no bone graft fusion or other internal fixation is performed, the postoperative vertebral joint instability will cause new symptoms.
5, extensive scar formation: In addition to scar patients, multiple surgical cases are also prone to cause extensive local scarring and formation of new compressive material.