Lumbar spinal stenosis is a condition characterized by intermittent claudication due to abnormal spinal canal structure and narrowing of the spinal canal cavity caused by primary or secondary factors. What are the categories of lumbar spinal stenosis? According to the international classification, it is divided into the following categories: 1. stenosis caused by 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 and 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 hyperplastic deformation and 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 in 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.Medicinal 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 suffering from trauma, chronic strain, and the attack of wind, cold, and dampness as the external factors of its pathogenesis. 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. What are the key points in the diagnosis of lumbar spinal stenosis? The main symptoms of lumbar spinal stenosis are chronic and recurrent lumbar 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 anterior tibialis and extensor muscles being the most obvious, 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 angiography, CT and MRI examinations can help clarify the diagnosis. How is lumbar spinal stenosis treated? Lumbar spinal stenosis is one of the conditions that cause chronic low back and leg pain, and the treatment of this disease mainly includes conservative treatment and surgical treatment. Commonly used conservative treatment includes: 1. Manipulation: The purpose of manipulation is to activate blood and relax tendons, disperse blood stasis, loosen adhesions, and relieve symptoms. Commonly used techniques are pressing and kneading, 扌扌法, 拿法, rubbing, rubbing and passive movement of lower limb flexion and extension. 2.Acupuncture and moxibustion treatment: Take lumbar Yangguan, Kidney Yu, Large Intestine Yu, Qihai Yu, Life Gate, Huanjiao, Fengshi, Guizhong, Kunlun and other acupuncture points, once a day, 10 times for a course of treatment. 3, drug treatment: for the nerve root of the sterile inflammation can be used analgesic anti-inflammatory drugs such as fotarine, fenbid, etc.. Chinese medicine treatment should be warming the meridians, strengthen the tendons and bones, available to supplement the kidney and strengthen the tendons soup plus reduction, commonly used drugs such as Shu Di, gun ginger, Du Zhong, cow knee, system dog spine, sequestra, etc.. If there is deficiency of qi and blood, add Astragalus, Radix Codonopsis, Radix Angelicae Sinensis and Radix Paeoniae Alba. For those who have cold pain in the back and legs, add chicken blood vine, douhu, gui zhi, epimedium, etc. 4, closed treatment: available epidural closure, can eliminate swelling, loosen adhesions, relieve symptoms, commonly used prednisolone acetate 12.5mg plus 1% procaine 10ml, once a week. 5, medical sports: can strengthen the back extension muscle, abdominal muscle muscle exercise, so that the stability of the lumbar spine increased, thus delaying the rate of 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. Back 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.