Legs heavy walking, do not ignore the lumbar spinal stenosis?
Many people work hard all their lives, but after retirement, they find themselves often back and leg pain, walking not far, at first the pain is still tolerable, with the growth of age, waist and leg pain will become more and more serious, and even inch difficult to walk, even buy a grocery, cooking are greatly affected, the happy life after retirement often become a bubble. This indicates that the lumbar spine has become more problematic and the lumbar spinal canal has become narrower.
Degenerative lumbar spinal stenosis is caused by degenerative changes in the lumbar spine due to disc herniation, ligamentous hypertrophy, and osteophytes that cause narrowing of the spinal canal and compression of nerves.
It has a high prevalence in middle-aged and elderly people and is the most common cause of low back and leg pain in the middle-aged and elderly population. Lumbar spinal stenosis is the manifestation of spinal stenosis in the lumbar spine area, mainly with long-term recurrent low back pain, sometimes the pain can be radiated to the lower limbs, usually with low back pain first, and gradually with leg heaviness and leg pain, and some patients will have serious symptoms such as lower limb numbness, chills, weakness, and even muscle atrophy, urinary and faecal and sexual dysfunction. The typical manifestation of patients with lumbar spinal stenosis is intermittent claudication. The so-called intermittent claudication is that after walking for a period of time (usually hundreds of meters, or tens of meters in severe cases), the patient will experience lumbar pain, numbness and weakness of one or both lower limbs, and even claudication, but after squatting or sitting down and resting for a few minutes, the above symptoms can be relieved or disappear, and then the patient can continue walking again, and after walking for a period of time, the above symptoms will appear again, and as a last resort, it is necessary to squat or sit down again to rest for a After walking for a while, the above-mentioned symptoms appear again, and as a last resort, the patient needs to squat or sit down again to rest for a few moments. Because the limp occurs intermittently during this process, it is called intermittent claudication. The performance of intermittent claudication can gradually worsen, that is, the distance that can be adhered to walking is getting shorter and shorter, and the time needed to rest is getting longer and longer.
It is worth mentioning that the most obvious feature of this type of claudication is that the symptoms are aggravated when the lumbar spine is in an extended position and relieved when bending over. This is because the volume of the lumbar spinal canal becomes smaller when the lumbar spine is in extension and larger in forward flexion. Many patients with spinal stenosis feel normal when walking with their hands in a wheelchair or shopping cart, but their pain worsens when standing upright. Because spinal stenosis is a chronic degenerative process, early symptoms are often not obvious and patients often have a less than clear history of chronic low back pain and mild activity limitations. These symptoms often worsen with activity or work and are relieved with rest, but the pain in the lower back and hip usually does not disappear immediately. This is like a water pipe in disrepair, due to the rusting of the inner wall, the thickening of the wall, the narrowing of the lumen, the water coming out is getting smaller and smaller, and eventually the lumen is blocked and the water flow is interrupted. At first, because the symptoms are mild, many patients often do not take it seriously and consider it as a normal phenomenon of human aging.
In terms of treatment, non-surgical treatment can be tried for early cases with relatively mild symptoms.
Medication can relieve the pain to some extent, mainly using non-steroidal anti-inflammatory and analgesic drugs. However, these drugs can sometimes produce side effects such as GI irritation, leukopenia, and liver and kidney damage if taken for a long time. Functional exercise is also part of the non-surgical treatment. Patients can move their lumbar joints and stretch their limbs through methods such as exercise equipment and low back muscle exercises. These methods are safe and have certain clinical effects. The use of infrared light and ultrasonic heat therapy can also improve the blood circulation of the lumbar muscles and nerve tissues and relieve pain. In addition, a lumbar belt can be worn for protection, which aims to strengthen the stability of the crest and has a better effect on those with slip secondary to stenosis, but it should not be used for a long time because long-term use can lead to lumbar muscle atrophy.
Non-surgical treatment only relieves the symptoms to a certain extent and to a certain degree. When the pain develops to the extent that it continues to affect the patient’s normal life and work, surgery should be considered.
In recent years, minimally invasive surgical methods and concepts have entered the field of crestal surgery. On the one hand, the use of crestal endoscopes such as discoscopes can remove the patient’s lesions such as hyperplastic ligaments, bony bulges and protruding nucleus pulposus through very small skin incisions (0,7 to 1,6 cm) to relieve nerve compression and eradicate the root cause of the disease; on the other hand, surgical magnification devices (head-mounted magnifiers, operating microscopes) have begun to be used in routine crestal surgery. With the magnification equipment, the fine structures such as nerve tissues and blood vessels can be clearly identified, avoiding medical misinjury, protecting and maximizing the preservation of normal tissues, greatly improving the therapeutic effect of crestal surgery, and reducing surgical complications. After surgery, you can generally leave bed in two or three days (not one month or even three months of bed rest), and you can be discharged home in three or five days. Minimally invasive surgery is not only safe among the various surgical categories, but also has a good prognosis and is the least risky in terms of risk.
The specific treatment plan should be carried out only after a specialized imaging examination. For example, CT and MRI examinations can clarify the degree of lumbar vertebral degeneration, in which vertebral body the growth is located, and whether there are deformities in the lumbar spine or whether there is a combination of other vertebral lesions. If it is accompanied by lumbar spine slippage or scoliosis deformity, it is important to choose advanced professional technical equipment and clinically experienced doctors for surgical treatment so that complications such as vertebral instability can be effectively avoided.
Spinal stenosis can be prevented, but it is necessary to adhere to the usual correct exercise. Lumbar exercise can maintain the curvature of the normal lumbar spine, which can prevent spinal stenosis, and the exercise can be achieved at home. If the lumbar curvature is large, should adhere to the bending and hands on the knees of the bed exercise every day, exercise 50 – 100 times a day, after a month, you will feel the legs strong, limp also reduced; if the lumbar curvature is small, tends to become straight, you need to exercise the back stretch back approach, or in bed supine, bending knees, abdominal, practice 50 – 100 times a day –100 times, exercise for a month, can also make the symptoms of early lumbar spinal stenosis reduce or even disappear. People with strong lumbar work should wear a protective belt at work to prevent excessive load on the lumbar spine.
How can I tell if I really have lumbar spinal stenosis?
The diagnosis of any disease cannot be made without careful history taking and physical examination. History taking is to understand what pain the disease has caused the patient, and physical examination is to determine if the doctor has a certain disease through physical methods such as basic looking, touching, moving, measuring, and some specialized techniques. On this basis, the doctor will have a preliminary clinical impression, and then further confirm the diagnosis through some auxiliary examinations such as imaging, so as to make a clinical diagnosis. This is the same process for patients suspected of having lumbar spinal stenosis. The doctor will first take a medical history and physical examination, and when the disease is suspected, a frontal and lateral X-ray of the lumbar spine can be taken to understand whether there is significant lumbar degeneration, and on this basis, a CT and MRI scan of the lumbar spine will be performed to clarify whether there is lumbar spinal stenosis.
Lumbar spinal stenosis does not allow me to walk long distances, but cycling is not affected, how is this?
One characteristic of lumbar spinal stenosis is that the symptoms often appear when the patient stands still or extends his back for a long time, but when he changes his position, such as bending forward or squatting or walking with a bent back, the symptoms are reduced or disappear, and the patient often prefers to maintain a bent back position. This is because when the lumbar spine is in extension or posterior extension, due to the protrusion of the ligamentum flavum, it causes the volume of the spinal canal to become smaller, which increases the degree of compression; while the volume of the spinal canal tends to increase in forward flexion, and the symptoms improve. When riding a bicycle, the lumbar forward flexion improves the compression of lumbar spinal stenosis to some extent, so the patient is not affected by cycling, but cannot walk long distances for a long time.
Are lumbar spinal stenosis and lumbar disc herniation the same thing?
These are two different diseases. Many people attribute lumbar and leg pain in middle-aged and elderly people to lumbar disc herniation, but in fact, the more common cause of lumbar leg pain in middle-aged and elderly people is lumbar spinal stenosis, the similarity between the two is that they both belong to degenerative diseases of the lumbar spine, the difference is that lumbar disc herniation is only a bad disc, the other structures of the crestal spine are basically normal; while lumbar spinal stenosis, with age and time accumulation, on the basis of disc degeneration These hard and soft factors cause the narrowing of the spinal canal in general, thus causing the compression of the nerve roots and cauda equina.
Can young people also get lumbar spinal stenosis?
There are two types of lumbar spinal stenosis: primary and secondary. Primary lumbar spinal stenosis, also known as congenital spinal stenosis, is caused by growth and developmental dysplasia, which includes short pedicles, short spacing between the pedicles on both sides, the so-called small joints on both sides coming closer to the center, hypertrophy of the vertebral plate, and hypertrophy or variation of the posterior edge of the vertebral body or small joints. Secondary lumbar spinal stenosis is caused by acquired factors, including hypertrophy and laxity of the ligamentum flavum, disc herniation, vertebral body dislocation, and osteophytes at the posterior edge of the superior articular eminence and vertebral body.
Because there are some people who have congenital developmental factors present, their own spinal canal is relatively narrow, and therefore can cause significant nerve compression when there are mild acquired degenerative factors such as disc herniation, thickening of the ligaments, bony bulge at the posterior edge of the vertebral body, and hyperplastic coalescence of the articular processes. Therefore, although lumbar spinal stenosis is mostly seen in middle-aged and elderly people, in some patients with developmental spinal stenosis, its onset can occur at an earlier age, with symptoms appearing in the 30s and 40s, and even requiring surgery.
Is surgery risky? Can it be paralyzing?
Crestal surgery is relatively risky, so you need to choose an experienced surgeon. In general, the lumbar spine area is already the cauda equina, the end of the cremaster, and complete damage is unlikely. In recent years, minimally invasive surgical methods and concepts have entered the field of crestal surgery. On the one hand, the use of crestal endoscopes such as intervertebral discoscopes can remove the patient’s lesions such as hyperplastic ligaments, bony bulges and protruding nucleus pulposus through very small skin incisions (0,7 to 1,6 cm), relieving nerve compression and eradicating the root of the disease; on the other hand, since surgical magnification equipment (binocular magnifier, operating microscope) has begun to be used in routine crestal surgery, the nerves can be clearly identified under a magnified field of view On the other hand, since surgical magnification equipment (binocular loupe, surgical microscope) has been used in routine crestal surgery, under the magnified view, the fine structures such as nerves and blood vessels can be clearly identified, avoiding medical misinjury, protecting and maximizing the preservation of normal tissues, greatly improving the therapeutic effect of crestal surgery and reducing surgical complications. In addition, preoperative assessment of cardiopulmonary function is required to determine whether the patient can tolerate surgery. Hypertensive diabetic patients with stable control can have surgery.
What happens if I don’t have surgery?
Lumbar spinal stenosis is a degenerative change, which means that it will continue to worsen with age, mainly in the form of shorter walking distances. If the compression is severe, nerve paralysis or nerve damage may even occur, manifesting as foot drop and incontinence. At this point, even if surgery is performed, the effect will be greatly reduced.