Spondylotic stenosis

　　Spondylotic stenosis has different causes depending on the type of disease, and its main causes are as follows.

　　1, Developmental lumbar spinal stenosis:This type of spinal stenosis is caused by congenital developmental abnormalities.

　　2, Degenerative lumbar spinal stenosis:It is mainly caused by degenerative changes in the spine.

　　3, Spondylolisthesis-related lumbar spinal stenosis:When the vertebral slip occurs due to the non-union or degeneration of the lumbar isthmus, the anterior and posterior displacement of the upper and lower vertebral canals further narrows the spinal canal, and the vertebral slip itself can promote degenerative changes, further aggravating spinal stenosis.

　　4, Traumatic spinal stenosis:Spinal stenosis often occurs when the spine is injured, especially when severe injury leads to spinal fracture or dislocation.

　　5, Iatrogenic spinal stenosis:In addition to surgical errors, it is often due to the thickening of the interspinous ligament and the yellow ligament or the thickening of the vertebral plate at the graft site after spinal fusion surgery. Especially after posterior laminectomy and local bone graft fusion, the result is narrowing of the spinal canal, compressing the cauda equina or nerve roots, and causing lumbar spinal stenosis.

　　6, Various inflammatory diseases of the lumbar spine:This includes specific or non-specific inflammation, neoplasms in the spinal canal or on the canal wall, and various deformities such as senile kyphosis, scoliosis, ankylosing spondylitis, fluorosis, Paget's disease, and spondylolysis can all cause spinal stenosis.

　　Spinal stenosis can be accompanied by lumbar disc prolapse, lateral recess stenosis, and lumbar disc herniation.

　　The symptoms of spinal stenosis refer to a series of lumbar and leg pain and neurological symptoms caused by various forms of spinal canal, nerve canal, and intervertebral foramen stenosis, as well as changes in spinal canal volume caused by soft tissue and the intrinsic stenosis of the dura mater. This condition is known as lumbar spinal stenosis. It is more common in men aged 40 to 50, especially in the lumbar 4-5 and lumbar 5-sacral 1 regions. The main symptoms are lumbar and leg pain, often with radicular pain on one or both sides. Severe cases can cause weakness of the lower limbs, relaxation of the sphincter muscles, urinary and fecal incontinence, or mild paresis. Another main symptom of spinal stenosis is intermittent claudication. Most patients experience worsening of lumbar and leg pain symptoms when standing or walking, feeling pain, numbness, and weakness in the lower limbs after walking a short distance, which becomes worse with continued walking. When slightly squatting or sitting down, the symptoms of lumbar and leg pain and claudication alleviate. The main cause of intermittent claudication may be related to stimulation or compression of the cauda equina or nerve roots. The specific symptoms are described as follows.

　　1, Most patients with lumbar spinal stenosis have a history of lower back pain or are accompanied by lower back pain. The pain is generally mild and can be relieved or disappear with bed rest. There are no restrictions on forward bending of the waist, but the extension activity is often limited.

　　2, Cauda equina syndrome. Lumbar spinal stenosis can lead to compression of the cauda equina, causing symptoms and signs in the saddle area and symptoms of the sphincter muscles. In severe cases, symptoms of urinary and sexual dysfunction may occur.

　　3, Obvious lumbar and leg pain symptoms and intermittent lameness. This is the most important manifestation of spinal stenosis. Patients often experience lumbar and leg pain after walking a distance of one or two hundred meters, and the symptoms will immediately subside or disappear after bending over to rest for a while or squatting. If they continue to walk, the pain will reappear soon. The symptoms worsen when the spine is extended and alleviate when it is flexed forward.

　　4. Compression of the cauda equina and nerve roots can affect urination and defecation, and even cause incomplete paralysis of the lower limbs. Patients with spinal stenosis often have many complaints but few signs. The vertebral column deviation is not obvious, the lumbar spine is normal, and only pain after extension. The straight leg raising test is normal or only moderate pain on mild stretching. A few patients have muscle atrophy in the lower limbs, and the Achilles reflex is sometimes weakened or absent.

　　4. Compression of the cauda equina and nerve roots can affect urination and defecation, and even cause incomplete paralysis of the lower limbs. Patients with spinal stenosis often have many complaints but few signs. The vertebral column deviation is not obvious, the lumbar spine is normal, and only pain after extension. The straight leg raising test is normal or only moderate pain on mild stretching. A few patients have muscle atrophy in the lower limbs, and the Achilles reflex is sometimes weakened or absent.

　　The preventive measures for spinal stenosis include maintaining correct labor posture, cultivating good living habits, not sitting or standing for too long at a desk, and using protective belts, etc., the specific preventive measures are described as follows.

　　1. Pay attention to reasonable labor posture and good living habits in daily life. When lifting heavy objects, bend the hips and knees to squat, keep the back straight, and the heavy object tightly pressed against the body before exerting force to stand up and step forward. When carrying heavy objects on the back or shoulders, slightly bend the chest forward and the hips and knees, step steadily, and do not take large steps. When sleeping, the head and neck should be in a natural neutral position, the hips and knees slightly bent, and avoid the body being exposed to wind, dampness, and cold.

　　2. Avoid sitting or working at a desk for too long. It should be avoided to keep one posture for a long time, which can cause soft tissue fatigue. Pay attention to warm-up and protection before剧烈 exercise.

　　3. For professions with high lumbar labor intensity, protective wide belts should be worn. To prevent spinal stenosis, one must first have a good living habit, such as not sitting or bending the neck for too long. Good posture should be cultivated from daily life habits to prevent spinal stenosis.

　　The examination of spinal stenosis includes X-ray, CT, MRI, and cerebrospinal fluid examination, etc., the specific examination methods are described as follows.

　　1. Anteroposterior X-ray film:It often shows mild lateral curvature of the lumbar spine, decreased distance between the articular processes, and degenerative changes.

　　2. Lateral X-ray film:The sagittal diameter of the spinal canal is usually small in the central part, less than 15mm indicating the possibility of stenosis.

　　5. If necessary, lumbar puncture, Quecken test, cerebrospinal fluid examination, and myelography can be performed.

　　4. Myelography:The reliable method for diagnosing this condition. The anteroposterior view can clearly show the size of the spinal subarachnoid space. If there are striated or root-like shadows, it indicates that the cauda equina nerve roots are compressed or completely obstructed. If the shadow column shows segmental narrowing or interruption, it indicates multiple or complete obstruction.

　　5. CT, MRI examination:The ratio of size between the peritoneal sac and bony vertebrae changes, the peritoneal sac and nerve roots are compressed, the epidural fat disappears or decreases, the articular processes become thickened, causing the lateral recess and spinal canal to narrow, with a tri-lobed spinal canal, and the intervertebral and posterior longitudinal ligaments become thickened.

　　6, Laboratory examination:The protein in cerebrospinal fluid may be increased to varying degrees.

　　The diet of patients with spinal stenosis should be light, and more foods rich in calcium, selenium, and zinc should be eaten; spicy and irritating foods should be avoided. The specific dietary precautions are as follows.

　　1, This disease is more common in middle-aged and elderly people, and the diet of patients should be light, and easily digestible foods should be eaten. Greasy and thick foods should be avoided.

　　2, For patients with blurred vision and tearing, it is advisable to eat more foods rich in calcium, selenium, and zinc, such as soy products, animal liver, eggs, fish, mushrooms, asparagus, carrots, etc. For patients with hypertension, it is advisable to eat more fresh vegetables and fruits, such as sprouts, kelp, mushrooms, garlic, celery, sweet potatoes, winter melon, mung beans, etc.

　　3, For patients with liver and kidney deficiency in cervical spondylosis, it is advisable to take Chinese wolfberry and chrysanthemum to calm the liver and improve eyesight, sesame seeds, longan, nourishing yin and tonifying kidney. Spicy and irritating foods should be avoided.

　　Spinal stenosis is more common in males aged 40-50, especially in lumbar vertebrae 4-5 and lumbar vertebrae 5-sacral vertebrae 1. In addition to the lumbar spine, spinal stenosis also often occurs in the cervical spine. Compared with other diseases, the early symptoms of spinal stenosis are not obvious, and only when the disease progresses to a certain degree, will there be unilateral or bilateral radicular radicular neuralgia. However, for this disease, if it is not treated at the beginning of the onset, it is difficult to achieve a good effect, so people should be cautious about this disease. Some patients, as age increases, the symptoms can also be relieved after the lumbar segmental stability is self-reconstructed. Non-surgical treatment is mostly used to cure or improve most patients.

　　Firstly, for atypical cases, non-surgical therapy should be adopted first, such as bed rest, traction, massage, physical therapy, and drug therapy. At the same time, it should be avoided to catch a cold and overwork, in order to promote the recovery of symptoms of nerve stimulation. For typical cases that are ineffective after non-surgical therapy, surgical treatment should be considered.

　　Secondly, surgery is mainly to remove the entire vertebral plate and completely decompress. So-called complete decompression refers to not only sufficient height and width in removing the vertebral plate, but also to remove the proliferative bone in the posterior part of the vertebral body (anterior part of the vertebral canal) and the lateral recess, in order to completely relieve all the compressions on the cauda equina and nerve roots.

　　1, Rest and functional exercise: For patients with severe pain, it is advisable to rest in bed to alleviate symptoms. After the symptoms are alleviated, the patient should wear a lumbar belt to get out of bed and engage in lumbar and back muscle functional exercises, in order to regulate metabolism and consolidate the efficacy.

　　2, Massage: It has the effects of relaxing tendons and meridians, promoting blood circulation and removing blood stasis, and reducing inflammation and pain. It can be used for patients with soft tissue injury and intervertebral disc protrusion, but attention should be paid to the selection of indications and the operation of手法.

　　3, Acupuncture: Electro-acupuncture, silver needle, ear acupuncture, moxibustion, cupping, etc.

　　4, Physical therapy: Hot compress, ultra-short wave, low-mid frequency, specific electromagnetic wave, multi-functional spectrum, laser, etc., have the effect of improving local blood circulation.

　　5, Traction: Chronic lumbar strain and intervertebral disc protrusion patients can use pelvic horizontal traction.

　　6, Pain points and acupoint sealing drugs: Angelica sinensis, Salvia miltiorrhiza injection, or 2% procaine 2-4ml added with prednisolone 25mg can be used. It can be taken once every 5-7 days, and can be taken continuously for 3-4 times. The treatment effect is good for patients with obvious pressure pain points.

　　7. Treatment with Chinese and Western medicine: Oral or external application of prepared Chinese patent medicine, which has the effects of relaxing tendons and collaterals, promoting blood circulation and removing blood stasis, such as Yunnan Baiyao, Sanqi Tablets, Die Dazhen Pill, Hu Gu Gao, Guxian Tablets, and Guitie Xia Tongye. Common Western medicine for anti-inflammatory and analgesic use includes Indomethacin, Indolacrin, Ibuprofen, Fenbid, etc. If there is muscle spasm, it is also possible to take Shujinling Tablets.

　　Thirdly, surgical treatment is suitable for patients with partial conservative treatment failure or severe symptoms, indications for surgical treatment:

　　1. There is significant neurological dysfunction, especially in patients with cauda equina dysfunction.

　　2. Long-term non-surgical treatment is ineffective, and symptoms are severe.

　　3. Most mixed spinal stenosis. The operation requires the relief of pressure on the dura mater and nerve roots. The procedures include laminectomy, excision of thickened yellow ligament, partial resection of superior articular process, enlargement of nerve root canal, and resolution of nerve adhesions. The standard for complete decompression is the restoration of the pulsation of the dura mater and the sliding range of nerve roots above 1 cm. For those with intervertebral joint instability before surgery, fusion of both vertebral plates and articular processes is required.

　　Minimally invasive techniques are a common method for treating spinal stenosis surgery. This therapy can avoid large incisions, using small incisions or puncture channels, applying special instruments and devices, under the monitoring of imaging instruments or guided by navigation technology, from normal anatomical structures to the lesion site, using various miniature manual or electric instruments and equipment, to complete the entire surgical process under visual conditions. Minimally invasive techniques are completed through a series of expansion channels to establish the surgical approach, and through a 1.6 cm working channel to complete operations such as interlaminar fenestration, nucleus pulposus removal, nerve root decompression, and bony decompression that could only be completed through open surgery in the past. It makes up for the shortcomings of traditional surgery, such as large incisions, extensive damage to soft tissues, and bone and joint structures, and better preserves the integrity of the posterior ligament complex of the spine, thereby effectively reducing the occurrence of postoperative lumbar instability and long-term lower back pain. To a great extent, it reduces the trauma of surgery, shortening the postoperative recovery time of patients significantly.