Monday, June 22, 2020

What is lumbar spinal stenosis?

Lumbar spinal stenosis refers to abnormalities in the structure of the spinal canal caused by primary or secondary factors, narrowing of the lumen of the spinal canal, and low back and leg pain characterized by intermittent claudication.

What are the types of lumbar spinal stenosis?

According to the international classification, it is divided into the following categories:

(1) Stenosis caused by degeneration of the spine: the spine is affected by changes in the elderly and strains, which causes the thickening of the lamina and the hyperplasia of the vertebral body, which causes the volume of the vertebral canal to shrink, resulting in stenosis and small joints Hypertrophy and hypertrophy of the yellow ligament.

(2) Stenosis caused by complex factors: congenital and congenital malformation of the stenosis, intervertebral disc herniation reduces the volume of the spinal canal, or the combined cause of the disc herniation and the mild stenosis of the spinal canal.

(3) Stenosis caused by spondylolisthesis (degenerative) and osteolysis.

(4) Iatrogenic stenosis: postoperative bone hyperplasia and scar hyperplasia adhesion caused by nucleolysin injection.

(5) Traumatic stenosis: such as compression fracture and fracture dislocation.

(6) Others: Malformed osteitis (Pagets disease) has spine deformation, and the spinal canal can be reduced; fluorosis can also cause hyperplasia and deformity, causing 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: mainly caused by degenerative disease of the spine.

(3) Spondylolisthesis of the spinal spine: When the spondylolisthesis occurs due to the unconnected or degenerated lumbar spine, the vertebral canal is further narrowed due to the displacement of the upper and lower vertebral canals, and the spondylolisthesis can promote degenerative changes. Increases spinal stenosis.

(4) Traumatic spinal stenosis: When the spine is traumatized, especially when the trauma is severe, spinal fracture or dislocation often causes spinal stenosis.

(5) Iatrogenic spinal stenosis: In addition to surgical errors, it is mostly due to hypertrophy of the interspinous ligament and ligamentum flavum after spinal fusion or thickening of the lamina in the bone graft, especially after decompression of the posterior lamina Local bone graft fusion surgery results in narrowing of the spinal canal and compression of the cauda equina or nerve roots, causing lumbar spinal stenosis.

(6) Various inflammations of the lumbar spine: including specific or non-specific inflammation, new organisms in the spinal canal or on the wall can cause spinal stenosis. Various deformities such as senile kyphosis, scoliosis, ankylosing spondylitis, skeletal fluorosis, Paget's disease, and loosened vertebral can cause spinal stenosis.

From the perspective of traditional Chinese medicine, congenital deficiency of kidney qi, deficiency of kidney qi, and injury to the kidney from labor are the internal factors of the onset. If repeatedly suffered from trauma, chronic strain, and the invasion of wind, cold and dampness, it is an external factor for its onset. The pathological mechanism is that kidney deficiency is not solid, wind, cold, dampness, qi stagnation and blood stasis.

What are the diagnostic points of lumbar spinal stenosis?

Lumbar spinal stenosis is common among middle-aged and older people, with more males than females. The main symptoms of the patient are long-term repeated low back pain and intermittent claudication. The nature of the pain is soreness or burning pain, and some can be radiated to the outside or front of the thigh, etc., mostly bilateral, and the left and right legs can alternate symptoms. When standing and walking, there is back and leg pain or numbness. The pain and lameness gradually increase, and they can't even continue to walk. The symptoms improve after resting, and there is no hindrance to cycling. Severe illness can cause urgency or dysuria. Some patients may have muscle atrophy of the lower extremities, the most obvious is the tibialis anterior and extensor muscles, the limbs have decreased pain, the knee or Achilles tendon reflexes are slow, and the straight leg elevation test is positive. However, some patients complain more and do not have any positive signs.

Taking X-rays of the lumbar spine in the positive, lateral, and oblique positions is helpful for diagnosis. It is often seen in the lumbar 4-5, lumbar 5 sacral 1 between the narrow intervertebral space, bone hyperplasia, spondylolisthesis, lumbosacral angle increase, small Hypertrophy of the facet joints and other changes. Intraspinal angiography, CT, and MRI examinations can help confirm the diagnosis.

How to treat lumbar spinal stenosis?

Lumbar spinal stenosis is one of the conditions that cause chronic low back pain. The treatment of this disease mainly includes conservative treatment and surgical treatment.

Commonly used conservative treatments are:

(1) Manipulative therapy: The purpose of manipulative therapy is to promote blood circulation, relieve muscle stasis, loosen adhesions, and relieve symptoms. Commonly used techniques are passive movements such as rubbing, rubbing, holding, rubbing, rubbing, and flexion and extension of the lower limbs.

(2) Acupuncture treatment: Acupoints such as Yaoyangguan, Shenshu, Dachangshu, Qihaishu, Mingmen, Huantiao, Fengshi, Weizhong, Kunlun can be taken once a day, 10 times a course.

(3) Drug treatment: Analgesic and anti-inflammatory drugs such as futulin and fenbide can be used for aseptic inflammation of nerve roots. The traditional Chinese medicine should be suitable for warming meridians, strengthening muscles and bones, and can be used to add or remove kidney and strengthening muscle soup. Commonly used medicines include Shu Di, Pao Jiang, Eucommia, Achyranthes, Astragalus, and Dipsacus. Those with qi deficiency and blood deficiency add astragalus, codonopsis, angelica and white peony. For those with low back pain, add Centipede, Duhu, Guizhi, Epimedium, etc.

(4) Closed treatment: It can be closed with epidural to eliminate swelling, loosen adhesions and relieve symptoms. Commonly used prednisolone acetate 12.5mg plus 1% procaine 10ml once a week.

(5) Medical sports: It can strengthen the muscle strength exercise of the back extensor muscles and abdominal muscles to increase the stability of the lumbar spine, thereby delaying the speed of the degeneration and evolution of the lumbar spine joints. Tai Chi 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 may be considered.

What are the surgical indications for lumbar spinal stenosis?

The indications for surgery are:

(1) Low back and leg pain after activity, which affects life and work, and does not heal after conservative treatment.

(2) Progressive claudication worsens, or the standing time gradually decreases.

(3) Those with obvious defects in nerve function.

The purpose of the surgery is to relieve the compression of nerve tissue and blood vessels in the spinal canal, nerve root canal or intervertebral foramina. Common surgical methods are laminectomy and nerve root decompression.

Is lumbar disc herniation the same thing as lumbar spinal stenosis?

Lumbar spinal stenosis refers to the bone or soft tissue that constitutes the spinal canal. Due to congenital development or acquired degeneration, various forms of narrowing of the spinal canal, nerve root canal, intervertebral foramen, etc., Causes the cauda equina nerve or nerve root to be compressed or stimulated, and a series of clinical manifestation syndromes appear. The clinical manifestations of lumbar spinal stenosis are:

(1) Intermittent claudication: When the patient stands upright or walks, the lower limbs gradually experience different pains, numbness, heaviness, fatigue, etc., so that they have to change their posture or stop walking. The symptoms can be reduced after squatting or resting for a while Or disappear, continue to stand or walk, the symptoms reappear and forced to rest again. Due to repeated walking and rest, the walking distance is gradually shortened. There is no need for intermittent lameness when climbing or biking.

(2) Low back pain: Most patients with lumbar spinal stenosis have a history of low back pain or accompanied by low back pain. The pain is generally mild, the bed rest is reduced or disappeared, the anterior waist flexion is not restricted, and the backward extension activity is often restricted.

(3) Symptoms and signs of nerve root compression: Nerve root canal stenosis causes corresponding nerve root compression or irritation symptoms and signs. Some patients show intermittent claudication, others show persistent radioactive nerve root symptoms, mostly soreness, numbness, bloating pain, channeling pain, the degree of pain is different. The location of nerve root symptom is related to the compressed nerve root, which is manifested by weakened acupuncture, abnormal pain, weakened muscle strength and abnormal tendon reflex in the corresponding nerve root distribution area.

(4) Compression of cauda equina nerve: Lumbar spinal stenosis can cause compression of cauda equina nerve, symptoms and signs of saddle area and symptoms of sphincter, and symptoms of urination and defecation can occur in severe cases.

Diagnosis of lumbar spinal stenosis: appropriate auxiliary examination methods should be selected according to clinical manifestations, such as X-ray plain film, myelography, CT scan, CT myelography, nuclear magnetic resonance, etc. of various projection methods to make accurate positioning , Qualitative and quantitative diagnosis. The biggest difference with lumbar disc herniation is: lumbar disc herniation generally does not have intermittent claudication, the main complaint is inconsistent with the objective examination, the lumbar posterior extension is limited to three major symptoms, lumbar disc herniation flexion neck test and straight leg elevation test are many Is positive, while lumbar spinal stenosis is negative. In addition, lumbar spinal stenosis is significantly different from lumbar disc herniation in imaging, that is, lumbar spinal stenosis shows that the sagittal signs of the spinal canal are less than normal during CT, MRI, and myelography, while the lumbar disc Protrusion is not. The two are separate diseases, but at the same time there is a certain connection, which can occur concomitantly, and the proportion of concomitant is quite high, which is why people tend to confuse the two. Because in the late stage of lumbar disc herniation, due to the synovial inflammatory exudation reaction of the corresponding facet joints, the articular cartilage is worn and fragmented, resulting in the proliferation of osteophytes at the lateral posterior edge of the vertebral body and the articular process, secondary to the lumbar spinal canal Stenosis. When the two diseases occur at the same time, the patient can show both symptoms and signs at the same time, and there is no difficulty in clinical diagnosis.

Lumbar spinal stenosis

symptom:

Can be obvious symptoms of low back and leg pain and intermittent claudication. Patients often have back and leg pain when walking for one or two hundred meters. After bending down for a while or squatting, the symptoms will be alleviated or disappeared immediately. If they continue to walk again, the pain will appear again soon. Symptoms worsen when the spine is stretched out, and relieved when it is flexed forward. A small number of cases affect the large and small urine due to the compression of the horsetail and nerve roots, and even cause incomplete paralysis of the lower extremities. Patients with spinal stenosis often complain more and have fewer signs. Check that the spine deflection is not obvious, the lumbar spine is normal, but the back pain. Straight leg elevation test is normal or only moderate stretch pain. A few patients have muscle atrophy of the lower extremities, and the Achilles tendon reflex sometimes weakens or disappears.

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