Lumbar spinal stenosis is a type of disease in which various causes shorten the diameter of the spinal canal, compressing the dural sac, spinal cord or nerve roots, resulting in corresponding neurological dysfunction. It is one of the causes of common lumbar spine diseases such as low back pain and low back and leg pain, also known as lumbar spinal stenosis syndrome, which mostly occurs in middle-aged people over 40 years old. It is often asymptomatic at rest, but after walking for a certain distance, symptoms such as pain, numbness and weakness in the lower extremities appear and need to be relieved by squatting or sitting down for a while before continuing to walk. With the aggravation of the disease, the walking distance becomes shorter and the rest time becomes longer. Tang Hengtao, Department of Orthopedics, First Affiliated Hospital of Zhengzhou University
Etiology
Lumbar spinal stenosis is a common disease in orthopedics, and its causes are very complex, ranging from congenital lumbar spinal stenosis to degenerative diseases of the spine, as well as spinal fractures or dislocations caused by trauma or spinal stenosis after lumbar surgery. The most common of these is degenerative lumbar spinal stenosis. Primary lumbar spinal stenosis: caused solely by congenital bone development abnormalities, which is less common clinically; secondary lumbar spinal stenosis: caused by intervertebral disc vertebrae, degenerative joint degeneration or spinal slippage, traumatic fracture dislocation, deformational osteitis, etc. The most common of these is degenerative spinal stenosis.
Clinical manifestations
The disease is insidious in its onset and slow in its course, and is most likely to occur in men between the ages of 40 and 50. The causes of stenosis are complex, and depending on the clinical stenosis site, the typical symptoms of patients may include: long-term lumbosacral pain, leg pain, progressive weakness and numbness of both lower limbs, intermittent claudication, and difficulty walking. Among them, numbness can gradually progress upward from the feet to the calves, thighs and lumbosacral region, and a girdling sensation in the abdomen, and in severe cases, abnormal urination and defecation and paraplegia. Doing lumbar hyperextension can cause increased numbness and pain in the lower limbs, which is a positive hyperextension test and an important sign for the diagnosis of spinal stenosis.
1. Long-term repeated low back pain, sometimes radiating to the lower limbs.
2.Intermittent claudication
When the patient stands or walks, back pain, leg pain or numbness, weakness, cramps appear, and gradually worsen to the point that he cannot continue walking. After sitting or squatting for a few minutes, the above symptoms disappear and walking can be continued, because there is an interval, so the name is intermittent claudication.
3.Some patients
There may be lower limb numbness, coldness, weakness, some muscle atrophy and numbness in the saddle area, urinary and fecal incontinence or urinary urgency or difficulty in urination, etc.
4.Doing lumbar hyperextension movement
This is a positive hyperextension test, which is an important sign for the diagnosis of spinal stenosis.
Examination
1. Frontal and lateral X-ray of the lumbar region
2. Lumbar puncture and spinal canal angiography
3.CT and CTM examination
4. MRI examination
5. other, such as electromyography, etc. (can help determine the location of the compressed nerve and differential diagnosis).
5. Generally, it is necessary to take frontal and lateral, oblique X-rays of the lumbar spine, and sometimes it is necessary to take lateral films of hyperextension and hyperflexion. Spinal space narrowing, osteophytes, osteoarthritic changes in small vertebral joints can be seen, mostly between lumbar 4-5 and lumbar 5 sacral 1.
6, CT examination can be seen sagittal diameter less than 12mm, with posterior extension of bone spurs, etc., generally take the lumbar 4-5, lumbar 5-sacral 1 small joint level CT film.