Thoracic vertebral canal stenosis

　　Thoracic spinal stenosis refers to a disease caused by congenital or acquired degenerative factors, leading to compression of the thoracic spinal cord and nerve roots, resulting in corresponding clinical symptoms and signs. The three most common causes of thoracic spinal stenosis are ossification of the yellow ligament, thoracic disc herniation, and ossification of the posterior longitudinal ligament. These three factors are both independent and interrelated. Other rare causes include posterior osteochondral nodules of the posterior margin of the thoracic vertebral bodies, diffuse idiopathic skeletal hyperostosis, fluorosis, and others.

　　Ossification of the yellow ligament of the thoracic spine (OLF)

　　This is the most common cause of thoracic spinal stenosis, accounting for more than 80-85% of all cases of thoracic spinal stenosis. Although a large number of studies have been conducted, the etiology is still not very clear. It is speculated that it may be related to stress concentration (thoracic-lumbar and cervical-thoracic segments), degenerative factors, genetic factors, and racial differences (Japanese and Caucasian). Moreover, the disease is often associated with ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, fluorosis, and abnormal calcium-phosphorus metabolism. The disease has an insidious onset and rapid progression, and most patients develop the disease before the age of 50.

　　Thoracic disc herniation (TDH)

　　It is the second most common cause of thoracic spinal stenosis, accounting for about 15%, and the vast majority occur in the lower thoracic spine. Autopsy studies and imaging studies suggest that asymptomatic TDH accounts for 11%, and surgical treatment of TDH accounts for about 0.2% to 2% of all thoracic and lumbar intervertebral disc removal surgeries. Clinical findings show that TDH often occurs with Shmorl's disease, and the intervertebral disc prolapse seen often has calcification, which is more common in young patients; for older patients, TDH often occurs with posterior osteophytes and hyperplasia of the small joints or thickening of the yellow ligament in the thoracic vertebral bodies, and other spinal degenerative factors. In addition, studies have shown that the spinal kyphosis angle of the corresponding and adjacent segments of the lumbar intervertebral disc prolapse is significantly greater than that of the normal population, which may lead to increased local stress and accelerate the damage to the intervertebral disc.

　　OPLL (Ossification of the Posterior Longitudinal Ligament)

　　OPLL is relatively rare, accounting for about 5%, but it is the most challenging cause to treat. OPLL is a common cause of cervical spondylosis in Asians, but it is relatively rare in the thoracic spine because OPLL causes compression of the ventral aspect of the spinal cord, and the kyphosis of the thoracic spine makes it difficult to achieve the effect of spinal cord retreatment with traditional posterior decompression. In addition, the ossified posterior longitudinal ligament is widely adherent to the dura mater, which also affects the effect of posterior decompression.

　　本病应及时到专科医院就诊，明确诊断，在有经验的专科医生指导下，选择正确的治疗方法。做到早确诊，早治疗。由于本病危害较大，如不能及时治疗，可导致病情加重并发其他疾病。病情严重者，短时间即可并发截瘫。截瘫是指脊髓损伤后，受伤平面以下双侧肢体感觉、运动、反射等消失和膀胱、肛门括约肌功能丧失的一种病症。其中，上述功能完全丧失者，称完全性截瘫，还有部分功能存在的，称不完全性截瘫。早期为弛缓性瘫痪，约3～4周后，逐渐转为痉挛性瘫痪。

　　胸椎管狭窄的主要表现为脊髓受压导致的一系列上运动神经元受损的临床表现，隐匿起病，逐渐加重，早期仅感觉行走一段距离后，下肢无力、发僵、发沉、不灵活等，一般没有明显的下肢疼痛麻木，休息片刻又可继续行走，我们称之为脊髓源性间歇性跛行，这与腰椎管狭窄症中常见的以疼痛、麻木为主要特征的神经源性间歇性跛行有显著不同。

　　随病情进展，出现踩棉花感、下肢活动僵硬、行走困难、躯干及下肢麻木与束带感，大小便困难、尿潴留或失禁，性功能障碍等，严重的可出现瘫痪。有一部分患者压迫位于胸腰段，表现为下运动神经元受损临床表现，如广泛的下肢肌肉萎缩、下肢无力、感觉丧失等。

　　但是要注意到许多胸椎管狭窄症的患者同时合并颈椎病或腰椎退行性疾病，往往会造成疾病的漏诊或误诊，因为脊髓的损伤多数是不可逆的，建议出现上述症状的患者应及时到正规专科医院就诊，以免贻误最佳诊疗时机。

　　本病应及时到专科医院就诊，明确诊断，在有经验的专科医生指导下，选择正确的治疗方法。做到早确诊，早治疗。预防本病的重点在于减少积累伤。平时要有良好的坐姿，睡眠时的床不宜太软。长期伏案工作者需要注意桌、椅高度，定期改变姿势。职业工作中需要常弯腰动作者，应定时伸腰、挺胸活动，并使用宽的腰带。应加强腰背肌的训练，增加脊柱的内在稳定性，长期使用腰围者，尤其需要注意腰背肌锻炼，以防止失用性肌肉萎缩带来不良后果。如需弯腰取物，最好采用屈髋、屈膝下蹲方式，减少对腰椎间盘后方的压力。

　　胸椎管狭窄症的诊断需要结合临床表现及影像学表现，首先通过询问病史和症状，确定问题来源于胸脊髓受损，然后可通过相应的影像学检查（X线平片、核磁和CT）来确定病变的类别、部位、范围、程度，分析临床表现与影像学有无明确的对应关系，与主要相关疾病进行鉴别诊断后即可确诊。具体检查如下：

　　1、胸椎X线平片

　　由于复杂的胸椎结构，仅能发现不到50％的OLF或OPLL病变。但是作为一项基本检查仍能提供许多重要信息。如发现有椎体楔形改变，则有可能有椎间盘突出；发现有DISH、强直性脊柱炎、氟骨症，则可能有OLF；如发现有下颈椎连续性OPLL，则可能有胸椎OLF等。

　　2、核磁检查

　　可清楚显示整个胸椎病变及部位、病因、压迫程度、脊髓损害情况，是确

　　诊胸椎管狭窄症最为有效的辅助检查方法。此外，临床上有10％以上的胸椎管狭窄症的病例是在行颈椎或腰椎核磁检查时偶然发现了OLF或胸椎椎间盘突出。

　　3、CT检查

　　可以清晰显示骨性椎管及骨化韧带的结构，对手术治疗提供有效信息。

　　本病应及时到专科医院就诊，明确诊断，在有经验的专科医生指导下，选择正确的治疗方法。做到早确诊，早治疗。预防本病的重点在于减少积累伤。平时要有良好的坐姿，睡眠时的床不宜太软。长期伏案工作者需要注意桌、椅高度，定期改变姿势。职业工作中需要常弯腰动作者，应定时伸腰、挺胸活动，并使用宽的腰带。应加强腰背肌的训练，增加脊柱的内在稳定性，长期使用腰围者，尤其需要注意腰背肌锻炼，以防止失用性肌肉萎缩带来不良后果。如需弯腰取物，最好采用屈髋、屈膝下蹲方式，减少对腰椎间盘后方的压力。在饮食上应注意以下方面:

　　一、椎管狭窄患者应少吃哪些食物

　　1、油腻食品，如烧烤类食物。

　　2、辛辣刺激性食物。

　　3、含磷的饮料以及酵母产品。

　　4. Some foods that inhibit calcium absorption, such as almonds, asparagus, cashews, rhubarb, and spinach, etc.

　　2. Diet Recipes

　　Black Bean Walnut Pig Kidney Soup

　　Ingredients: 90 grams of black beans, 60 grams of walnuts, and one kidney of the pig.

　　Method: Boil the ingredients in boiling water, and it can be eaten after it is cooked.

　　Kidney Slices Porridge

　　Ingredients: One kidney of the pig, 100 grams of glutinous rice, and appropriate amounts of scallion, salt, monosodium glutamate, ginger, and yellow wine.

　　Method: Clean the kidney of the pig, remove the tendons, cut it into pieces, and put it into boiling water. Then clean the glutinous rice, cook it into porridge, and then add the kidney slices and other ingredients, and boil it before eating.

　　Doucin Sheep Kidney

　　Ingredients: 50 grams of Doucin, four sheep kidneys.

　　Method: Cut open the kidney of the sheep and clean it, then roast and grind Doucin into fine powder, put it into the sheep kidney, wrap it with lotus leaves, wrap it with two layers of wet paper outside, and cook it slowly with low heat. At the same time, a little wine should be added.

　　Once the disease is diagnosed, everyone should actively seek treatment in order to help everyone return to normal life as soon as possible. In terms of treatment, for atypical cases of spinal stenosis compressing nerves, non-surgical therapy should be adopted first, such as bed rest, traction, massage, physical therapy, and drug therapy. At the same time, one should avoid catching cold and overexertion to promote the recovery of neurological symptoms. For typical cases that are ineffective with non-surgical therapy, surgical treatment should be considered. The surgery for spinal stenosis compressing nerves mainly involves the complete removal of the vertebral plates to achieve complete decompression.

　　1. Bed Rest:Bed rest can improve local venous return, make sterile inflammation reaction subside, reduce intramedullary pressure, and relax the lumbar and back muscles. Generally, the subjective symptoms will alleviate after 2 weeks of bed rest.

　　2. Massage, Manipulation and Physical Therapy:Massage and manipulation can accelerate blood circulation, reduce muscle spasms, but the technique must be gentle. Physical therapy can eliminate local inflammation, relieve muscle spasms, and alleviate symptoms.

　　3. Lumbar and Back Muscle Exercise:The instability of the spine is related to the strength of the lumbar and back muscles and the degree of osteoporosis. The purpose of lumbar and back muscle exercise is to strengthen the stability of the thoracic and lumbar spine, which helps to slow down the speed of spinal degeneration.

　　4. Drug Therapy:Some traditional Chinese medicine treatments for activating blood circulation and removing blood stasis can also alleviate the clinical symptoms of patients.