Mr. Wang, who is almost 60 years old, came to Dr. Ding Yongli’s clinic in a wheelchair and said with distress, “I can play mahjong with my friends for a long time, but after standing for a long time or walking for a while, both legs are so tired and weak that they can’t support the weight of my body, so I have to sit down quickly to rest before my symptoms disappear. I can’t do any work, I look like a good person, and the village folks say I’m pretending to be sick.”
After careful examination, Director Ding suggested that the patient do a lumbar spine CT examination, which showed that the patient’s lumbar spine had osteophytes and the spinal canal, which was wide, had become narrow. Director Ding told Mr. Wang that he was suffering from lumbar spinal stenosis and needed surgery. After hospitalization, Mr. Ding performed lumbar spinal canal enlargement, nerve decompression, and fixed fusion surgery on Mr. Wang. A week later, Mr. Wang got out of bed and found that all of his original symptoms were gone. Ding Yongli, orthopedic injury treatment center of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine
Regarding the cause of lumbar spinal stenosis, Dr. Ding Yongli said that lumbar spinal stenosis refers to the segment of the lumbar spinal canal and nerve roots penetrating the lumbar spine due to degeneration and hyperplasia, resulting in narrowing of the canal lumen, causing pressure on the nerve roots and cauda equina and producing the corresponding clinical symptoms. This disease has a slow onset and long course, and is a common disease causing lumbar and leg pain, mostly seen in middle-aged and elderly people, about 80% occurring between the ages of 40 and 60, more common in men than women, and more common in manual workers. It is mainly divided into three types: congenital, secondary and mixed with two factors, of which lumbar degeneration is the main cause. “Intermittent claudication” is the main manifestation of lumbar spinal stenosis, characterized by unilateral or bilateral lower limb distress, heaviness, and weakness after walking, which is relieved by squatting or sitting down for a period of time, and then the same symptoms appear again if walking continues. The pain is relieved or disappears after resting or bending, and is aggravated by prolonged standing, lumbar back extension or walking for a certain distance. Patients often say that it is difficult to walk with a straight back, while the lower extremity symptoms are not obvious when walking with a bent back. Another interesting phenomenon, Dr. Ding Yongli said, is that patients walk as far as they can on a bicycle without symptoms. The symptoms of lumbar spinal stenosis and the signs examined by the doctor are inconsistent, or as we often say, the symptoms are heavy and the signs are light, and the patient says a lot of symptoms but the doctor can’t find many signs on physical examination. This type of disease is characterized by fibrous stenosis of the lumbar spinal canal, and the symptoms usually do not resolve on their own, so surgery is preferred for those with severe symptoms or those for whom systematic conservative treatment is ineffective, with the aim of relieving the compression of the nerves and their feeding vessels in the spinal canal.