Lumbar spinal and root canal decompression

A typical vertebra is composed of anterior vertebral body and posterior vertebral arch. The vertebral body and the vertebral arch form a vertebral foramen, and the vertebrae of all vertebrae are connected to form a spinal canal. The vertebral arch is arch-shaped and consists of a pair of pedicles, a pair of vertebral arches, a spinous process, a pair of transverse processes, and two pairs of articular processes. The pedicle is short and thin, horizontal, and is connected to the posterolateral side of the vertebra. The upper and lower edges of the pedicle are each recessed, called the upper vertebrae notch and the lower vertebrae notch. The upper and lower incisions of two adjacent vertebrae form an intervertebral foramen, through which spinal nerves and blood vessels pass. The nerve root channel from the spinal canal to the foraminal exit is the root canal, which is bounded by the isthmus and the lower part of the arch root. The root canal can be divided into the entrance zone, middle zone, and exit zone. There are bony lateral recesses on the inside of the foramen at the level of the lumbar and iliac levels. Lumbar spinal stenosis is narrowly defined as the sagittal and transverse diameters of the lumbar spinal canal, which cause the morphological changes of the spinal canal and cause the symptoms and signs of compression of the cauda equina. In a broad sense: the narrowing of the intervertebral foramen tunnel in the crypt side of the nerve root canal [Figure 1⑴]. The formation of stenosis can be bony or soft tissue, or a mixture of the two. The reasons can be congenital (developmental), acquired (degenerative), iatrogenic and so on. In short, any change in the diameter of the spinal canal due to the above-mentioned reasons, or the narrowing of the diameter of the nerve root canal, causing symptoms of spinal cord and nerve root compression, are lumbar spinal canal stenosis. The etiology does not include spinal stenosis caused by tuberculosis, tumors, and lumbar disc herniation. Verbiest proposed that the median sagittal diameter of the lumbar spinal canal measured on x-ray films is less than 12mm as a criterion for diagnosing stenosis. The median sagittal diameter is between 10 and 12mm, which is relatively narrow, and less than 10mm is absolute stenosis. Non-surgical treatments include: massage, hot compresses, physical therapy, traction, rest, etc. Only for mild lumbar spinal stenosis. Typical cases should be treated surgically. Surgery should enlarge the spinal canal and nerve root canal to relieve compression of the cauda equina and lumbar nerve root. In order to determine the surgical site, preoperative positioning should be clearly defined, and examinations such as myelography, CT, and magnetic resonance imaging can be used.

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