I. What is lumbar spinal stenosis? Lumbar spinal stenosis is one of the causes of common lumbar spine diseases such as low back pain and lumbar 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 period of time, before being able to continue walking. With the aggravation of the disease, the walking distance becomes shorter and shorter, and the time needed to rest becomes longer and longer. Second, what are the causes of lumbar spinal stenosis? The causes include congenital lumbar spinal stenosis, degenerative diseases of the spine, and spinal fractures or dislocations caused by trauma or spinal stenosis after lumbar surgery. The most common of these is degenerative lumbar conus canal stenosis. Degenerative lumbar spinal stenosis is caused by degeneration of the intervertebral discs with age, resulting in hyperplasia of the ligaments and hypertrophy of the vertebral body and small joints, making the effective volume of the spinal canal in one or more planes smaller, resulting in compression of the cauda equina and nerve roots, thus causing symptoms such as lumbar and leg pain. Due to congenital or developmental narrowing of the spinal canal, coupled with lumbar disc degeneration after middle age, lumbar intervertebral instability, intervertebral joint loosening, resulting in lumbar degenerative changes, lumbar osteophytes, ligamentous laxity, hypertrophy or invagination, loosening of the synovial joint, hyperplasia or hypertrophy, vertebral plate hypertrophy, etc. can make the lumbar spinal canal internal diameter narrow, the effective volume of the spinal canal is reduced, and after reaching a certain level, it can cause spinal nerve root or cauda equina The spinal nerve root or cauda equina may be squeezed and the disease may develop. What are the main clinical manifestations of lumbar spinal stenosis? The main symptoms are long-term recurrent back and leg pain and intermittent claudication. The nature of the pain is i-pain, stabbing pain or burning pain, and some of them can be radiated to the outer thigh or front and back. It is mostly bilateral and can alternate between left and right. Intermittent trekking is the characteristic of this disease, more than 80% of patients have intermittent trekking, often after walking and exercising unilateral or both lower limbs numbness, heaviness, pain, weakness, the more walking the more serious the symptoms, often forced to stop and rest. Symptoms are relieved immediately after squatting, and the same symptoms appear if walking continues. In severe cases, urinary urgency or difficulty in urination may occur. Some patients may develop muscle atrophy of the lower limbs, with the most obvious being the tibialis anterior and thumb muscles, decreased pain sensation in the limbs, loss of knee or Achilles tendon reflexes, and less positive straight leg raise tests. When doing lumbar hyperextension, it can cause increased numbness and pain in the lower limbs, which is an important sign for the diagnosis of spinal stenosis. What tests should be done when lumbar spinal stenosis is suspected? 1. Generally, it is necessary to take frontal and lateral, oblique X-rays of the lumbar spine, and sometimes it is necessary to take additional lateral films of hyperextension and hyperflexion. It is possible to see narrowing of the spinal space, osteophytes, osteoarthritic changes in the small joints of the vertebrae, mostly between lumbar 4-5 and lumbar 5 sacral 1. 2, lumbar spine CT or CTM (myelography) can better display the transverse section of the spinal canal morphology, visible sagittal diameter less than 12mm (this measurement is accurate, high clinical value), posterior extension of bone spurs, fat in the spinal canal is extruded displacement, dural sac deformation, the upper and lower articular processes of the vertebral plate hypertrophy or see the yellow ligament hypertrophy (normal below 5mm) disc protrusion compression of spinal nerve, sometimes can also see calcified post The posterior longitudinal ligament can sometimes be seen. 3, MRI (magnetic resonance imaging) of the lumbar spine has the unique advantage that it can basically replace the conventional X-ray iodine imaging of the spinal canal, providing a satisfactory and reliable imaging basis for the clinical diagnosis and treatment of spinal stenosis due to hypertrophy of the ligamentum flavum and the differential diagnosis of the causes of spinal stenosis. V. Treatment characteristics? 1.Manipulation therapy: with the patient in prone position and the doctor standing on the patient’s side, use palm root to press and knead along the lumbosacral region, along the Governor’s vein, down the bladder meridian, through the buttocks, the back of the thigh, the N fossa to the back of the calf and up and down 2 to 3 times, then press the lumbar Yangguan, Kidney Yu, Large Intestine Yu, the second s, the ring jump, Cheng Fu, Wei Zhong, Cheng Shan and other points. Flick the vertical spinal muscles on both sides of the lumbosacral region and knead the lumbar and leg regions. One assistant holds the patient’s armpit and one assistant holds the patient’s two ankles, and the two oppose traction. The two hands of the doctor are folded together and placed at the lumbar 4 and 5 vertebrae to perform pressure shaking. Generally require shaking 20 to 30 times. 2, in drug therapy: treatment should be warm meridians and channels, strengthen the tendons and bones, can be used to supplement the kidney and strengthen the tendons soup plus or minus, commonly used drugs are rehmannia, ginger, juniper, cow knee, system dog spine, sequesters, etc.. For deficiency of Qi and blood, add Astragalus, Radix Codonopsis, Radix Angelicae Sinensis and Radix Paeoniae Alba. For cold pain in the lower back and legs, add chicken blood vine, douhu, gui zhi, epimedium. 3, other therapies: (1) local closure therapy: can be carried out epidural closure, can loosen adhesions, relieve symptoms. Commonly used prednisolone 12.5 plus procaine 10-20ml, once a week, 3 times for a course of treatment. (2) Bed rest, application of braces, anti-inflammatory and pain-relieving drugs, intramuscular calcitonin injection, physical therapy, pelvic traction, lumbar and back muscle exercise, etc. (4) Surgery can be attempted if the symptoms cannot be relieved after conservative treatment. At present, there are about three types of surgery for spinal stenosis: simple decompression, decompression + fusion, and minimally invasive surgery. In view of the fact that many elderly patients cannot tolerate surgical trauma and cannot relieve severe lumbar and leg pain through conservative treatment, they can choose minimally invasive interventional techniques, which can rapidly relieve severe radicular neuralgia caused by nerve root compression by using imaging and positioning techniques under local anesthesia to precisely treat the lesion. What are the preventive measures for lumbar spinal stenosis? 1.Protection of the waist: sleep in a soft and hard bed, avoid sleeping in a bed that is too hard or too soft, so that the lumbar muscles can get sufficient rest; avoid the waist being attacked by wind and cold, and avoid the waist being in a posture for a long time and the muscle force being unbalanced, causing strain on the waist. 2, the waist application: correct use of the waist, lifting heavy objects should first squat, use the waist for too long should change the posture of the waist, do more lumbar activities to prevent the gradual occurrence of strain injury, the nature of the work and excessive use of the waist or has produced a mild strain injury, to avoid further aggravation of strain injury, and eventually cause degenerative changes in the lumbar spine. 3, lumbar health care exercise: adhere to the lumbar health care exercise, often carry out activities in all directions of the lumbar spine, so that the lumbar spine always maintain a state of physiological stress, strengthen the lumbar muscle and abdominal muscle exercises, lumbar muscle and abdominal muscle strength, can increase the stability of the lumbar spine, the lumbar protection ability to strengthen, prevent degenerative changes in the lumbar spine.