What Are the Treatments for Severe Spinal Stenosis?

Spinal stenosis (spinal stenosis) is a variety of reasons that cause the shortening of the spinal canal, compressing the dural sac, the spinal cord or the nerve root, resulting in a series of neurological dysfunctions such as pain, numbness, limb weakness, claudication, and urination A class of diseases. Spinal canal stenosis is divided into stenoses: cervical spinal canal stenosis, thoracic spinal canal stenosis, and lumbar spinal canal stenosis. The etiology is mainly divided into congenital spinal stenosis and acquired spinal stenosis.

Basic Information

English name: Spinal Stenosis
Visiting department: orthopedics

Common locations: Spinal canal
Common causes: Congenital malformations, bone hyperplasia, post-traumatic fractures, etc.
Common symptoms: Pain, numbness, physical activity, dysfunction of stool, etc.

Causes of spinal stenosis

The cause is mainly related to the following factors: congenital developmental malformations, mainly congenital small spinal canals, characterized by multi-segment spinal canal onset, early onset, obvious neurological symptoms; bone hyperplasia, yellow ligament hypertrophy, Longitudinal ligament ossification leads to a decrease in the spinal canal volume; narrow crypt and intervertebral disc disease, corresponding to the segmental spinal stenosis; post-traumatic fractures, vertebral spondylolisthesis; iatrogenic stenosis, cervical spine after cervical thoracolumbar spine Unstable secondary kyphosis and other deformities, deformed segments cause spinal stenosis.

Clinical manifestations of spinal stenosis

Cervical spinal stenosis

(1) Pain and numbness of cervical spinal canal stenosis. Neck pain often occurs, mostly soreness and soreness. Feeling numbness in the limbs, radiating pain in the upper limbs, may have discharge-like and burning-like pain.

(2) Limb movements, dysfunction of stool and stool, weakness of limbs, muscle atrophy, severe stenosis and mild external force can lead to paraplegia and incontinence. The perineum area is numb and sexual function is reduced.

2. Thoracic spinal stenosis

Thoracic spinal stenosis often causes chest and back pain, which often persists and is difficult to alleviate. The trunk feels numb below the spinal stenosis segment, and often feels girdle. Both lower limbs feel numb and weak. The anatomical structure of the thoracic spinal canal is narrower than that of the cervical spine and lumbar spinal canal, so the symptoms of numbness and weakness of the lower limbs appear earlier. Gait is unstable and limp.

3. Lumbar spinal stenosis

(1) Pain and muscle weakness Lumbar spinal stenosis is common in recurrent lumbar and back pain, radiating pain in the buttocks and lower limbs, followed by lower limb numbness and muscle atrophy. There are various types of pain, which can be sore, tingling, sore, electrical discharge and burning pain.

(2) Symptoms of compression of the cauda equina , unclean urination, uncontrollable stool, numbness in the perineal area, decreased sexual function

(3) Intermittent claudication This is a characteristic manifestation of spinal stenosis. Intermittent limping occurs while walking, and improves after standing or squatting to rest.

Spinal stenosis

1.X-ray

You can understand the curvature of the spine, intervertebral height, whether bone hyperplasia, articular process degeneration and hypertrophy, and whether the vertebrae have slippage.

2.CT

Bone vertebral canal morphology, vertebral canal cross-section bone structure, etc.

3.MRI

It can comprehensively observe whether there is any disease in the intervertebral disc, understand the degree and location of the nucleus pulposus, and identify the presence of other occupying lesions in the spinal canal.

Spinal stenosis diagnosis

Combined with clinical symptoms and CT and MRI examinations. The final clear diagnosis method is the measurement of symptoms and spinal canal line.

Differential diagnosis of spinal stenosis

Spinal cord spinal tumor

It can occur in all ages. Back pain is often the first symptom. It can appear numbness of the limbs, incontinence and limb weakness, paraplegia and other nerve root and spinal cord compression.

2. Motor neuron disease

Above clinical and lower motor nervous system involvement are the main manifestations, including muscle weakness, muscle atrophy, muscle bundle tremor and increased muscle tone, hypertenon reflex, and positive pathological signs. Generally there are no paresthesias and urination disorders.

3. Thrombo-occlusive vasculitis

It mostly occurs in young and mature men, and has a history of heavy smoking. Typical clinical manifestations are intermittent claudication, pain at rest, and traveling thrombophlebitis.

Spinal stenosis treatment

Non-surgical treatment

(1) Rest in bed.

(2) Continuous traction.

(3) Physical therapy, massage, massage.

(4) oral non-steroidal anti-inflammatory drugs or hormone epidural injection.

(5) Pain points are closed.

Non-surgical treatment was ineffective, and symptoms continued to worsen and pain. Problems with bowel movements. Affect daily life and work. Needs surgery.

2. Surgical treatment

(1) Cervical spinal canal stenosis Anterior approach: such as anterior cervical spine subtotal titanium cage implantation, anterior cervical discectomy and transvertebral decompression. posterior approach: posterior cervical decompression with minimally invasive discectomy, posterior decompression and fusion under posterior cervical microscope, posterior cervical spinal canal augmentation.

(2) Thoracic spinal stenosis: 360 ° circular decompression of the thoracic spine, thoracic spinal approach, subtotal vertebral canal decompression, titanium cage implantation.

(3) Lumbar spinal stenosis Anterior and lateral surgery: anterior lumbar spinal fusion, vertical lateral spinal decompression, interbody fusion, and extreme lateral spinal decompression, interbody fusion. Posterior approach: Percutaneous minimally invasive decompression of the spinal canal, percutaneous minimally invasive decompression of the posterior decompression, pedicle screw fixation, lumbar decompression of the spinal disc, lumbar spinal posterior decompression Mesenchymal decompression vertebral fusion, posterolateral decompression fusion of lumbar spine, posterior lumbar interbody fusion.

3. Precautions after surgery

(1) Patients should wear a cervical collar and waist protection for 4-6 weeks after operation. The spine should be integrated when turning over, and the shaft should be turned over. Avoid excessive movement to loosen the contents.

(2) Strengthen the activities of the extremities to prevent nerve root adhesion and pain again.

(3) Closely observe the movement of the extremities and the improvement of paresthesia. If the patient suffers from lower extremity pain, treatment with hormones and neurotrophy is available. Limb pain can be treated with non-steroidal anti-inflammatory drugs.

(4) Patients with ambulatory and limb movement disorders; passive activities need to be strengthened to avoid venous thrombosis, and lower limb pumps are needed to promote circulation if necessary. Patients with dysuria need to strengthen urinary tract care to prevent urinary tract infections.

(5) Appropriate waist weight bearing after discharge, moderate strengthening of lower back muscle strength, swimming and yoga can be done, and neurological rehabilitation treatment such as hyperbaric oxygen can be performed for those who still have neurological symptoms.