1. What is lumbar spinal stenosis?
Lumbar spinal stenosis is a common disease in orthopedics and is very different from lumbar disc herniation, but many patients are often confused. The typical symptoms of lumbar spinal stenosis are mainly manifested in three aspects.
(1) Intermittent claudication: It is the most typical symptom of lumbar spinal stenosis. The so-called intermittent claudication is commonly known as sitting or lying without any discomfort in the legs, but when you stand up, you feel numbness and weakness in one or both lower limbs, and you need to sit or lie down to rest after walking a certain distance. If you can walk a distance after resting, it is called intermittent claudication in medicine.
2) You can ride a bicycle: This is a very interesting symptom. Many patients with lumbar spinal stenosis are often unable to walk, and usually rely on bicycles to go out, and it is fine to ride for a long distance, but not as soon as they get off.
(3) No abnormalities on physical examination: When a lying doctor examines a patient with lumbar spinal stenosis, often the strength of the muscles and the sensation of the skin do not detect any abnormalities.
If the above three conditions occur, combined with CT or other imaging examinations can generally diagnose lumbar spinal stenosis. Of course, there are many diseases that cause lumbar spinal stenosis symptoms, and clinically, some other related examinations are sometimes needed to finalize the diagnosis.
In addition to the above symptoms, patients with lumbar spinal stenosis may also experience low back pain, leg pain, urinary and fecal incontinence, constipation, and numbness and pain in the lower extremities that can be aggravated by lumbar hyperextension.
2.What are the causes of lumbar spinal stenosis?
The main cause of lumbar spinal stenosis in the general sense is still related to the hyperplasia of the small joints of the lumbar spine, the hyperplasia of the ligamentum flavum in the spinal canal and the protrusion of the intervertebral disc.
Figure 1: Schematic diagram of lumbar spinal stenosis
3.What are the conservative treatment methods for lumbar spinal stenosis?
Conservative treatment can be considered for lumbar spinal stenosis if it does not seriously affect daily life and there are no abnormalities in urination or defecation. The main methods of conservative treatment include: neurotrophic drugs (methyl-vitamin B12, such as Micropôle, nerve growth factor, etc.); Chinese medicines (such as Danlu Tongdu tablets, Dahuoluo capsules, etc.); dehydration drugs (such as abortifacient, sodium hepaticoside, etc.); anti-inflammatory and analgesic drugs (such as Furtalin, Xilabao, etc.). In addition, it can be combined with abdominal muscle exercise, lumbar protection (lumbar girth), acupuncture, physiotherapy and other Chinese medicine and physical methods.
4.What is the basic principle of minimally invasive surgery for lumbar spinal stenosis?
Whether open or minimally invasive surgery, the basic principle is to remove the enlarged bone and ligaments to release the nerve compression. Minimally invasive surgery is nothing more than the use of a tube to precisely remove the compressed nerve tissue without the need for excessive muscle stripping or removal of excessive bone as in open surgery, thus reducing intraoperative muscle damage and bleeding and thus promoting rapid postoperative recovery.
5.What are the minimally invasive surgical methods for lumbar spinal stenosis?
There are various minimally invasive surgical methods for lumbar spinal stenosis, which need to be analyzed according to the symptoms and imaging examinations. It should be especially noted that many doctors now use radiofrequency and ozone treatments for lumbar spinal stenosis patients, actually taking advantage of the patient’s psychology of not wanting to have surgery, explaining to the patient that you can try and then have surgery if it doesn’t work. Many times patients spend money and are not cured because these methods do not remove the nerve compression, even if the relief is only temporary and does not have long-term effects. So don’t blindly follow the minimally invasive advice of some doctors, but go to a regular hospital and then determine the treatment method you want to use.
Minimally invasive surgical methods commonly used in clinical practice for lumbar spinal stenosis include.
(1) Discoscopic or minimally invasive access lumbar decompression: Currently, discoscopic or minimally invasive access lumbar decompression surgery is the main minimally invasive surgical procedure for the treatment of lumbar spinal stenosis. Both of them can do bilateral decompression of the spinal canal through one side of the surgery, which is the most common minimally invasive decompression method we use because of the small surgical trauma and early postoperative dismounting. Based on this, we have further improved this procedure (unilateral spinous split spinal canal decompression), and the results of the research were published in the world-renowned spine surgery journal Spine (Figure 2).
Figure 2 Lumbar spinal canal decompression with minimally invasive access
(2) Minimally invasive access decompression + minimally invasive screw fixation: For patients with severe lumbar spinal stenosis combined with lumbar instability, internal fixation with screws is required on top of decompression surgery, and the current screw fixation can also be fixed in a minimally invasive way, as described in my article “The surgical treatment of lumbar spondylolisthesis enters the minimally invasive era The details are described in my article “Lumbar spondylolisthesis surgery enters the era of minimally invasive treatment”.
(3) Intervertebral foraminoscopic lumbar decompression: This surgical procedure has been carried out clinically at present, but this surgical procedure is limited by the diameter of the channel and is only suitable for a small number of patients, and the surgical efficacy also awaits further follow-up.