Lumbar spinal stenosis is a series of low back pain and a series of neurological symptoms caused by various forms of narrowing of the spinal canal, neural canal, and intervertebral foramen, as well as soft tissue-induced changes in the volume of the spinal canal and narrowing of the dural sac itself. It is called lumbar spinal stenosis. Xiong Xuelin, Department of Pain and Massage, The Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine
Because of the narrowing of the spinal canal, the cauda equina nerve in the spinal canal is compressed, resulting in symptoms such as lumbar and leg pain. If the spinal canal is narrowed laterally, the nerve roots will also be compressed, causing interruption of the axial pulp due to pressure; obstruction of nerve fluid operation; relative expansion of the nerve sheath; stimulation of nerve endings; and tissue hypoxia due to obstruction of blood flow; restricted venous return and local stagnation, etc. These constitute the causes of low back pain.
Lumbar spinal stenosis is divided into the following categories?
1.Stenosis due to spinal degeneration: The spine is affected by age-related changes and strain, which causes thickening of the vertebral plate and hyperplasia of the vertebral body, resulting in volume reduction of the spinal canal, stenosis, hypertrophy of the small joints and hypertrophy of the ligamentum flavum, etc.
2.Stenosis caused by compound factors: stenosis caused by congenital and acquired deformities, stenosis caused by disc herniation that reduces the volume of the spinal canal, or stenosis caused by a combination of disc herniation and mild stenosis of the spinal canal.
3.Stenosis due to spondylolisthesis (degenerative) and osteolysis.
4.Medical stenosis: post-operative osteophytes and scar proliferation adhesions caused by myelin injection, etc.
5.Injury stenosis: such as compression fracture and fracture dislocation.
6.Other: deformational osteitis (Pagets disease) has spinal deformation, and the spinal canal can be narrowed; fluorosis can also cause hyperplasia deformation, resulting in stenosis.
What are the causes of lumbar spinal stenosis?
From the perspective of modern medicine, the common causes of lumbar spinal stenosis are as follows.
1, developmental lumbar spinal stenosis: this spinal stenosis is caused by congenital developmental abnormalities.
2. degenerative lumbar spinal stenosis: it is mainly caused by degenerative lesions of the spine.
3.Spinal slip lumbar spinal stenosis: When spinal slip occurs due to discontinuity or degeneration of the lumbar isthmus, the spinal canal is further narrowed because of the anterior and posterior displacement of the upper and lower spinal canal, while spinal slip can promote degenerative changes and aggravate spinal stenosis.
4.Traumatic spinal stenosis: Spinal stenosis is often caused by trauma to the spine, especially when the spine is fractured or dislocated due to severe trauma.
5.Medical spinal stenosis: In addition to surgical errors, it is mostly caused by the thickening of the interspinous ligament and ligamentum flavum after spinal fusion or the thickening of the vertebral plate in the bone graft, especially after decompression of the posterior vertebral plate and then local bone graft fusion, which results in narrowing of the spinal canal and compression of the cauda equina or nerve roots, causing lumbar spinal stenosis.
6, various inflammatory diseases in the lumbar spine: including specific or non-specific inflammation, new organisms in the spinal canal or on the canal wall can cause spinal stenosis. Various deformities such as age-related hunchback, scoliosis, ankylosing spondylitis, fluorosis, Paget’s disease and vertebral joint loosening can cause spinal stenosis.
From the perspective of Chinese medicine, congenital kidney deficiency, kidney deficiency, and strain injury to the kidney are intrinsic factors in the development of the disease. If repeatedly suffered from trauma, chronic strain, and the attack of wind, cold and dampness as the external factors of its development. The pathological mechanism is kidney deficiency, wind, cold and dampness blocking the ligaments, Qi stagnation and blood stasis, and Ying and Wei not being able to promote the flow, resulting in paralysis and pain in the back and legs.
The main symptoms of lumbar spinal stenosis are chronic and recurrent lumbar and leg pain and intermittent claudication. The nature of the pain is soreness or burning pain, some of which may radiate to the lateral or anterior thighs, mostly bilaterally, and may alternate between the left and right legs. When standing and walking, lumbar and leg pain or numbness and weakness appear, pain and limp gradually worsen, even can not continue to walk, the symptoms improve after rest, riding a bicycle without hindrance. In severe cases, it may cause urinary urgency or difficulty in urination. Some patients may develop muscle atrophy of the lower limbs, with the most obvious being the tibialis anterior and extensor muscles, hyperalgesia, dull knee or Achilles tendon reflexes, and positive straight leg raise test. However, some patients have more complaints and do not have any positive signs.
Taking frontal, lateral and oblique X-ray of the lumbar spine can help in diagnosis, and changes such as narrowing of the intervertebral space, osteophytes, slipped vertebrae, increased lumbosacral angle and hypertrophy of small articular processes are often seen between lumbar 4 to 5 and lumbar 5 sacral 1. Intraspinal imaging, CT, and MRI can help clarify the diagnosis.
What is intermittent claudication?
Intermittent claudication is a condition in which a patient starts walking or walks a certain distance (usually a few hundred meters) and then develops unilateral or bilateral lumbago, numbness and weakness of the lower limbs, or even a limp, but after a few moments of rest by squatting or sitting down, the symptoms can be relieved or disappear quickly, and the patient can continue walking, and then after walking for a period of time, the above symptoms reappear. Because in this process, the limp is intermittent, so it is called intermittent claudication.
The appearance of intermittent claudication is mainly due to the pathological basis of the existing stenosis of the lumbar spinal canal, the increased pressure load on the vertebral body and nerve roots when upright, plus the stretching and contraction activities of the muscles of the lower limbs during walking to further promote the physiological congestion of the blood vessels in the nerve roots of the corresponding spinal ganglia in the spinal canal, followed by venous stasis and ischemic radiculitis due to the blockage of microcirculation in the corresponding areas after the nerve roots are strained, resulting in When the patient squats, sits down or lies down, the pressure load on the nerve root is reduced, the source of stimulation during muscle activity is eliminated, and the ischemic state of the spinal cord and nerve root is improved, so the symptoms are reduced and disappear. When walking again, the above-mentioned symptoms appear again, and then rest, the symptoms are relieved again, and so on, alternately, forming intermittent claudication. It is one of the main clinical features of lumbar spinal stenosis.
How to identify intermittent claudication?
Lumbar spinal stenosis manifests as neurological intermittent claudication, which is different from vascular intermittent claudication (e.g. thrombo-occlusive vasculitis), and the difference is mainly in the following aspects.
1, neurogenic intermittent claudication with good dorsalis pedis artery pulsation, and vascular intermittent claudication with diminished or absent dorsalis pedis artery pulsation.
2, neurogenic intermittent claudication lower extremity can have segmental sensory disorders, vascular intermittent claudication for garter-type sensory disorders.
3, neurological intermittent claudication walking distance with the prolongation of the disease and gradually shortened, vascular intermittent claudication is not obvious.
4.If necessary, arteriography is feasible; neurogenic intermittent claudication has good arteries, and vascular intermittent claudication can show the arterial lumen stenosis area.
How to treat lumbar spinal stenosis?
Lumbar spinal stenosis is one of the conditions leading to chronic back and leg pain. Treatment for this disease mainly includes conservative treatment and surgery.
The commonly used conservative treatments are.
1.Manipulation treatment.
2.Acupuncture treatment.
3.Medication: For sterile inflammation of nerve root, analgesic and anti-inflammatory drugs such as Fotarine and Fenbid can be used. Chinese medicine treatment is appropriate to warm the meridians, strengthen the muscles and bones.
4.Closure therapy: Epidural closure can be used to eliminate swelling, loosen adhesions and relieve symptoms.
5, medical sports: can strengthen the back extension muscle, abdominal muscle muscle exercise, so that the stability of the lumbar vertebrae increased, thereby delaying the evolution of lumbar joint degeneration. Playing Taijiquan has a better effect on this disease.
6.Surgical treatment: If the above conservative treatment is invalid or the effect is not obvious, surgical treatment can be considered.
What are the indications for surgery for lumbar spinal stenosis?
The indications for surgery are
1.Lumbar and leg pain after activity, which affects life and work and is not cured by conservative treatment.
2. Progressive claudication is aggravated, or standing time is gradually shortened.
3.The nerve function is obviously deficient.
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 methods are laminectomy and nerve root decompression.