Spinal stenosis

Introduction to spinal stenosis Spinal stenosis refers to various forms of stenosis of the spinal canal, nerve root canal and intervertebral foramen, including changes in spinal canal volume caused by soft tissue (such as hypertrophy of the ligamentum flavum, calcification of the posterior ligament, etc.) and stenosis of the dural sac itself. Spinal stenosis occurs due to spinal cord and nerve and blood vessel compression and stimulation caused by spinal stenosis. The main symptoms are low back pain, often with radiation pain on one or both sides. Severe cases can cause weakness in both lower limbs, sphincter relaxation, discomfort or convulsions. Another major symptom of spinal stenosis is intermittent breaks. Most patients, when standing or walking, have aggravated symptoms of low back and leg pain, walking a short distance, that is, feeling lower limb pain, numbness, and getting heavier. When a little or slightly sitting, the symptoms of lower back and leg pain and the breakage are relieved. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: somatosensory disturbance

Cause of spinal stenosis

Spinal degeneration (25%):

Because the spine is affected by old age changes and strain, the lamina is thickened, the vertebral body is hyperplasia, and the volume of the spinal canal is reduced, resulting in narrowing, small joint hypertrophy, and hypertrophy of the ligamentum flavum.

Iatrogenic factors (20%):

The disease is caused by surgery, the main reasons: (1) surgical trauma and hemorrhagic scar tissue formation, adhesion to the dural sac and cause spinal cord compression. (2) excessive or extensive laminectomy, no bone fusion leads to cervical instability, causing secondary traumatic and fibrous structural hyperplasia. (3) After anterior cervical decompression and bone grafting, the bone protrudes into the spinal canal. (4) Failure of spinal canalplasty, such as hinge breakage.

Congenital developmental factors (15%):

In the early stage or in the absence of external injury factors, symptoms may not occur, but with degenerative changes in the spine (such as bone spurs, protruding discs, segmental instability, etc.). Or a trauma of the head and neck can further narrow the spinal canal, causing a series of clinical manifestations of spinal cord compression. Due to the reduction or disappearance of the reserve space during spinal stenosis, the spinal cord is closer to the anterior and posterior wall of the spinal canal in the spinal canal, so that even in the normal cervical flexion and extension, there may be stimulation and compression leading to spinal cord lesions.

Other lesions and trauma (10%):

Such as cervical spondylosis, cervical disc herniation, cervical posterior longitudinal ligament ossification (OPLL), cervical tumor, tuberculosis and trauma. However, this type of disease is an independent disease. Cervical spinal stenosis is only a part of its pathological manifestations, so it should not be diagnosed as cervical spinal stenosis.

Spinal stenosis prevention

method 1:

Usually pay more attention to reasonable labor posture and good living habits. When lifting heavy objects, the hips and knees bend and squat, the back of the waist is straight, and the weight can be pressed against the body before it can stand up and step forward. When you are on the back or squatting, the chest is slightly curved, the hips and knees are slightly bent, and the steps are stable. The steps should not be large. When sleeping, the head and neck should be naturally neutral, the hips and knees should be slightly bent, and the body should be protected from the wind and damp.

Method 2:

Do not sit for a long time, or work at the desk. You should avoid the fatigue of soft tissue caused by maintaining a posture for a long time. Before strenuous exercise, pay attention to preparation activities and protection.

Method 3:

For occupations where the waist is labor intensive, wear a protective wide belt. Prevention of spinal stenosis must first have good living habits, such as not sitting or looking down too long. Start with daily living habits and develop good posture to prevent spinal stenosis.

Spinal stenosis complications Complications

1. Lumbar disc herniation.

2. Lateral stenosis.

3. Lumbar disc herniation.

Symptoms of spinal stenosis Common symptoms Low back and hip pain... Intermittent claudication sensation of lower extremity, muscle... Nerve pain, limb numbness, abnormal reflex

The main symptoms are low back pain, often with radiation pain on one or both sides. Severe cases can cause weakness in both lower limbs, sphincter relaxation, discomfort or convulsions. Another major symptom of spinal stenosis is intermittent breaks. Most patients, when standing or walking, have aggravated symptoms of low back and leg pain, walking a short distance, that is, feeling lower limb pain, numbness, and getting heavier. When a little or slightly sitting, the symptoms of lower back and leg pain and the breakage are relieved. The main cause of intersexual breakage may be related to stimulation or compression of the cauda equina or nerve roots.

1. Most patients with lumbar spinal stenosis have a history of low back pain or low back pain. Pain is generally mild, rest in bed is reduced or disappeared, lumbar flexion is not restricted, and stretching is often limited.

2, cauda equina compression. Lumbar spinal stenosis can cause compression of the cauda equina, symptoms and signs of the saddle area and symptoms of the sphincter. In severe cases, symptoms of bowel movements and sexual life disorders may occur.

3, obvious symptoms of low back pain and intermittent claudication. This is the most important symptom of the symptoms of spinal stenosis. Patients often have low back pain when walking one or two hundred meters. After a short break or a squat, the symptoms will be relieved or disappeared immediately. If you continue to walk, the pain will appear again. Symptoms worsen when the spine is extended and the symptoms are relieved when flexion occurs.

4, oppression of the horse's tail and nerve roots affect the large, urinary, and even cause incomplete paralysis of the lower limbs. Patients with spinal stenosis often have multiple complaints and fewer signs. Check the spine deflection is not obvious, the lumbar spine is normal, but the pain is stretched. Straight leg raising test is normal or only moderate traction pain. A small number of patients have muscle atrophy in the lower extremities, and Achilles tendon reflexes sometimes weaken or disappear.

5, nerve root canal stenosis caused by the corresponding nerve roots are stressed or stimulated symptoms and signs. Some patients showed intermittent claudication, others showed persistent radioactive nerve root symptoms, mostly soreness, numbness, pain, and pain, and the degree of pain was different. The site of the radicular symptoms is related to the compressed nerve roots, which is characterized by attenuated acupuncture sensation, abnormal pain, weakened muscle strength and abnormal sacral reflex.

Examination of spinal stenosis

1. Orthotopic X-ray film : often shows mild lumbar curvature of the lumbar spine, the distance between the joints between the joints becomes smaller, and there is a degenerative change. Lateral X-ray films showed that the central sagittal diameter of the spinal canal was often small, and less than 15 mm indicated the possibility of stenosis. Lumbar puncture, quinine test, cerebrospinal fluid test, and myelography can be performed if necessary. Myelography is a reliable method for diagnosing this disease. The anterior slice can clearly show the size of the dural cavity. If there is streaky or fibrous shadow, it indicates that the cauda equina nerve root is under pressure or full obstruction. If the shadow column is segmental stenosis or interruption, it is indicated as multiple Sexual or total obstruction.

2, CT, MRI examination : the ratio of the size of the capsular sac and the vertebral vertebral body changed, the sheath sac and nerve root were compressed, the epidural fat disappeared or decreased, and the lateral crypt and the spinal canal narrowed. Trilobal spinal canal, intercostal ligament, and posterior longitudinal ligament hypertrophy.

3, laboratory tests : cerebrospinal fluid protein can be increased to varying degrees.

Diagnosis and differentiation of spinal canal stenosis

According to detailed medical history, clinical symptoms and signs, X-ray photographs and myelography, it is not difficult to diagnose, but it needs to be differentiated from lumbar disc herniation and thromboangiitis obliterans.

The judgment of cervical spinal stenosis is related to the treatment effect:

1. Magnetic resonance imaging examination : It can be directly observed that the anteroposterior diameter of the cervical spinal canal is narrowed, and the cervical spinal cord is subjected to front and rear pinching in the spinal canal, that is, the cervical vertebrae and the posterior longitudinal ligament are pressed in front, and the ligamentum and lamina are behind. The compression causes a bead-like change in the cervical spinal cord, accompanied by soft tissue edema or cervical spinal cord edema.

2, CT scan: patients with cervical CT scan, the cervical spinal cord is crescent-shaped, the anterior and posterior diameter of the cervical spinal cord is less than 4 mm (normally 6 mm ~ 8 mm). If the anteroposterior diameter of the cervical spinal canal is less than 10 mm, it is a developmental stenosis. Degenerative cervical spinal canal stenosis can be seen in the posterior margin of the vertebral body with irregular, dense osteophyte formation, may have calcification and ossification of the posterior longitudinal ligament, some patients have hypertrophy of the ligamentum flavum, the thickness of the ligamentum flavum can reach 4 mm ~ 5 mm (normally 2.5 mm to 3 mm), and wrinkles or calcification may occur in the ligamentum flavum. On different cross sections of the CT scan, cervical disc bulging or protrusion can be observed, and cystic changes can be made in the spinal cord.

3, clinical manifestations: cervical spinal stenosis mostly for the elderly, slow onset, gradually appear numbness, weakness, walking instability and other spinal cord compression symptoms. Symptoms often start from the lower extremities, and the patient walks unsteadily, especially when going downstairs, there is a fear of falling. The patient's limbs and trunk have reduced or disappeared sensation, decreased muscle strength, increased muscle tone, and increased or increased tendon reflexes in the extremities, leading to pathological reflexes. This shows that the judgment of the disease can not be ignored.

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