Lumbar Spinal Canal Stenosis

　　Lumbar spinal stenosis is a common disease in orthopedics, with a very complex etiology. It includes congenital lumbar spinal stenosis, degenerative diseases of the spine causing the condition, and spinal fractures or dislocations due to trauma, or spinal stenosis caused by lumbar surgery. The most common type is degenerative lumbar spinal stenosis. Primary lumbar spinal stenosis: caused solely by congenital bone developmental abnormalities, which is clinically rare; secondary lumbar spinal stenosis: caused by intervertebral disc and vertebral body degeneration, spondylolisthesis, traumatic fractures and dislocations, or osteitis deformans. The most common is degenerative spinal stenosis.

　　The most common complication of lumbar spinal stenosis is intermittent claudication. Patients with lumbar spinal stenosis may experience lower back and leg pain, which is a characteristic symptom of lumbar spinal stenosis. When the patient stands, the pressure load on the nerve roots increases, and the blood flow to the cauda equina increases when walking. However, the narrowed spinal canal necessarily hinders blood supply, leading to ischemic nerve root pain and intermittent claudication symptoms, that is, pain and limping after walking a certain distance. More than 75% of patients have this symptom, and most patients have long-term, recurrent low back pain, with pain characteristics such as soreness, tingling, and burning.

　　The most common complications after lumbar spinal stenosis surgery are adhesions and scars, followed by common infections. In addition, patients may experience instability of the spine, persistent back pain after leg pain disappears, organ damage, nerve damage, and possible nerve root injury during surgery in the epidural or intradural space.

　　Lumbar spinal stenosis is common in middle-aged and older people, with more males than females. The main symptoms of patients are long-term recurrent lumbar and leg pain and intermittent claudication. The nature of pain is soreness or burning pain, which may radiate to the outer or anterior side of the thigh, and is usually bilateral, with symptoms alternating between the left and right legs. When standing and walking, if there is lumbar and leg pain or numbness and weakness, the pain and claudication gradually worsen, and it may become impossible to continue walking. After rest, the symptoms improve. Severe cases may cause urgency or difficulty in urination. Some patients may experience muscle atrophy in the lower limbs, with the most obvious at the anterior tibial muscles and extensors. Limb pain sensation decreases, and the patellar or Achilles reflex is delayed. The straight leg raising test is positive. However, some patients may have many complaints but no positive signs.

　　The prevention of lumbar spinal stenosis is actually the prevention of lumbar degenerative changes. Generally, the preventive measures for this disease include the following points:

　　1. Appropriate activity

　　People who have been sitting or bending over for a long time should change their posture and position regularly, move their waist, and perform self-massage at the same time. When working, try to avoid activities in non-physiological positions, combine work and rest, and work moderately.

　　2. Pay attention to rest

　　The bed should be moderately soft and hard, avoiding a bed that is too hard or too soft, so that the lumbar muscles can get adequate rest, avoiding attacks of wind and cold on the lumbar region, and avoiding prolonged staying in the same posture, which can cause muscle imbalance and lumbar spinal stenosis.

　　3. Physical exercise

　　Appropriate physical exercise is another important method for preventing this disease. The spine is one of the main load-bearing parts of the human body, and the lumbar spine is the part with the heaviest load and the greatest range of motion. Under pathological conditions, various factors that maintain lumbar stability change, leading to degenerative changes in the lumbar spine and the occurrence of lumbar spinal stenosis. Appropriate physical exercise, especially lumbar exercise, can enhance metabolism, promote the excretion of various metabolic products, and ensure normal physiological function. In addition, it can also increase muscle strength and the toughness of tendons, thereby enhancing the stability of the spine, which can effectively prevent the occurrence of this disease.

　　4. Pay attention to diet

　　Increase the intake of calcium-rich foods such as milk, beans, etc., eat more fresh fruits and vegetables, diversify the diet, and drink less cola and other beverages. If the amount of food intake is low, appropriate nutritional supplements can be taken. Bean foods are very helpful in preventing lumbar spinal stenosis, and we should eat more bean foods in our daily diet.

　　Lumbar spinal stenosis is a common disease in orthopedics, with a complex etiology. Generally, the following examinations are required:

　　1. Lateral and anteroposterior X-ray films of the lumbar spine;

　　2. Lumbar puncture and spinal canal angiography;

　　3. CT and CTM examination;

　　4. MRI examination;

　　5. Other tests, such as electromyography (which can help determine the compressed nerve location and differential diagnosis).

　　For patients with lumbar spinal canal stenosis, it is necessary to pay attention to diet, be nutritious, eat more fruits and vegetables, and rich in protein foods, avoid spicy and刺激性 foods. The following is a specific introduction to the diet of this disease:

　　1. Eat more foods rich in vitamin C

　　Sweet potatoes, potatoes, cabbage, cauliflower, rapeseed, green peppers, coriander, celery, strawberries, persimmons, lemons, oranges, and other foods.

　　2. Eat more foods rich in protein

　　Pork, chicken, beef, animal liver, fish, shellfish, cheese, eggs, soybeans, soy products, and so on.

　　3. Eat more foods rich in calcium

　　Small fish, milk, cheese, yogurt, sesame, radish strips, leafy vegetables, seaweed, and so on.

　　Lumbar spinal canal stenosis mild and early cases are mainly treated with non-surgical methods, and those who are ineffective need to undergo surgical spinal canal decompression and fixation fusion.

　　1. Non-surgical Treatment

　　(1) Traditional non-surgical therapies mainly include: abdominal muscle exercises, lumbar protection, symptomatic treatment, physical therapy, massage, external application of medicine, and so on.

　　(2) Drug treatment mainly uses traditional Chinese medicine.

　　(3) Epidural blockage has a significant effect on some patients, which can significantly alleviate the symptoms of intermittent claudication.

　　2. Surgical Treatment

　　Surgical treatment is mainly applicable to: those who have failed non-surgical treatment; those with obvious radicular symptoms; for secondary lumbar spinal canal stenosis, progressive lumbar spondylolisthesis, and those with lumbar lateral or kyphotic deformities, who have corresponding clinical symptoms and signs.

　　(1) Decompression cases can be treated with traditional conventional methods including laminectomy, hemilaminectomy, and full laminectomy, as well as minimally invasive techniques.

　　(2) For cases that require 'decompression + fixation', traditional conventional treatment methods can be used, as well as minimally invasive techniques. Fusion techniques can include intertransverse process posterior lateral fusion, interspinous process posterior fusion, intervertebral fusion techniques, and so on.