Spinal stenosis
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■ Outline:
The next most common cause of back pain is the spinal stenosis.
The disease is very characteristic of the disease and can only be diagnosed by listening to the patient's appeal.
Symptoms of this disease, like a disc disease, are painful because of back pain and sore legs. However, the characteristic of this bottle is that if you walk for a long time or if you walk for a long time, you will have to sit and rest for a while, because you can not walk any longer because your legs are sore or sore as your legs are sore from one leg to the other.
Some patients say their legs feel numb, and their legs fall down. Sometimes the symptoms stretch from the soles to the hips. If you walk, you will have these symptoms again and you will have to rest and go back.
These symptoms are called "nervous intermittent claudication" in medical terms. If you have any of these symptoms, you should first suspect that you have spinal stenosis in your lower back.
■ Synonyms:
Lumbar spinal stenosis, degenerative anterior displacement, spinal stenosis
■ Definitions:
From the neck to the waist, there is a hole in the vertebrae that has the thickness of the second finger passing the nerve (spinal cord). This hole is called the spinal column. This hole is narrowed for various reasons, and the nerves going down to the legs in it are tight, so that the entire leg is broken and the paralysis occurs.
■ Symptom:
Almost all patients have chronic back pain.
However, the characteristic feature of this disease is that it has a "neurogenic intermittent claudication (NIC)" in which the legs should go to a sitting position when the legs are strangely painful, numb sensation, dull sensation, or exercise paralysis.
Even if there are no symptoms of lying down or resting, there is strange pain or numbness that is difficult to express in the lower limbs when you stand or walk to some extent. So there is an intermittent clause to go and rest, then to rest.
As the stenosis becomes worse and the walking time becomes shorter, it takes about 30 minutes in the beginning, and then it takes 20 minutes, 10 minutes, 5 minutes, 1 minute to get sick. Some grandmothers are only sitting in the room and moving.
■ Causes / Pathophysiology:
The causes of lumbar spinal stenosis include congenital stenosis, which is narrow from the birth to the spinal canal, but most of them are degenerative spinal stenosis, which is the aging phenomenon by age.
As our body ages, degenerative changes occur in the spine and disc, so the surrounding tissues surrounding the spinal column gradually become thicker and narrower.
In other words, every disc node, the vertebral tip of the spine is pointed, degenerative spurs protrude from the front of the spine, and on both sides of the back of the spine, the vertebral joint and ligament are thickened and the spinal canal narrows inward.
Stenosis due to degenerative spondylitis occurs in the 50s and 70s from the late 40s.
Some degenerative degenerative degenerative spondylolisthesis with the upper and lower vertebrae shifting from each other and the upper vertebrae slipping forward is unusual in many women in their 40s and 50s.
■ Diagnosis:
The most important thing in diagnosing spinal stenosis is the most important history and symptoms.
"If you lie down or take a break, you have strange pain or numbness that is difficult to express in your legs when you stand or walk a certain distance, so you go to rest, go and rest ..." With the history and symptoms of these patients, Diagnosis is possible and can be confirmed by various tests such as computed tomography (CT) and magnetic resonance imaging (MRI).
Test method
Simple x-ray
It is the simplest and most commonly used test method. You can observe degenerative changes in the vertebral bones. However, the degree of stenosis is not known, and other surveillance is required.
Spinal angiography
After inserting a needle into the vertebra, the contrast agent is inserted into the spinal cord to check the degree of compression of the spinal cord.
Since it is the most commonly used test method only 4 to 5 years ago, it is a test that inserts a needle into a patient's spine and causes pain. Therefore, the frequency of use is decreasing after the introduction of MRI.
Spine CT
This is the most commonly used test.
It is helpful to set the treatment method and to set the surgical method because it can tell the lesion of the lumbar disc precisely and know the degree of compression of the spinal cord nerve.
In recent years, CT examinations have been able to be deducted from medical insurance, reducing the economic burden on patients.
Spinal MRI
This is the most accurate diagnostic method. Especially, it is necessary to establish the surgical plan by showing the degree of the stenosis by various images as the test which best shows the abnormality of the spinal cord nerve. There is a disadvantage that the inspection cost is high because the insurance is not applied yet.
■ Progress / Prognosis:
The prognosis of lumbar stenosis is good.
In the early stages of lumbar stenosis, bed rest or physical therapy alone can heal pain.
However, if the pain persists after a period of stabilization and physical therapy, surgical treatment is needed. Surgery is the release of the stressed spinal cord (spinal cord decompression) and the success rate of the surgery is more than 90%. Particularly, patient's walking is improved and walking is possible to far.
■ Complications:
The most common complication of spinal stenosis is paralysis.
Paralysis includes exercise paralysis, sensory paralysis, large-scale urine paralysis, and sexual function paralysis. If you have any of these complications (symptoms of paralysis), you should seek medical attention and receive proper treatment. After an appropriate period of treatment, it may be a permanent disability, or it may be a lifetime disability.
In some patients, there are symptoms of marked paralysis in the legs, and even if they do not move their ankles, they may miss the surgery due to the false prejudice of 'back surgery'. In this case, the patient's paralysis does not recover even after surgery is.
■ Treatment:
At first, stabilization is the best treatment.
Stabilization for about 2 to 3 weeks usually improves the initial mild stenosis. Physical therapy such as hot poultice, ultrasound therapy or traction device may be effective when stable.
If you are in severe pain, you may take medication for analgesic purposes, but you should be careful not to abuse medicines that are good for neuralgia.
In the case of conservative treatments such as stable fascias or physical therapy, if the pain does not improve and the pain continues, or the symptoms improve to some extent, or if the neurological abnormality is severe, Is helpful.
There are several ways to use the surgery.
The important thing here is that the surgery is not the best, and the choice of surgery is the most important.
Minimally Invasive Surgery
Minimally invasive surgical techniques may be limited in patients with vertebral stenosis. In principle, minimally invasive surgical techniques such as intra-disc injection therapy, percutaneous disc aspiration, and percutaneous endoscopic discectomy are rarely effective in spinal stenosis.
Lumbar laminectomy
It is the most commonly used surgical procedure to widen the passage of the spinal nerve by removing the lumbosacral spinal cord in the area with stenosis.
However, many patients with spinal stenosis are accompanied by spinal instability, so a simple lumbar laminectomy is often accompanied by a worsening spinal instability after surgery.
In recent years, lumbar laminectomy is performed after spinal fusion.
Fusion fusion
It is a surgery that fixes the spine using a device to fix the spinal instability after the spinal nerve is sufficiently loosened by the lumbar laminectomy at the part where the stenosis is present.
Recently, its frequency of use has been gradually increasing, and it is currently used worldwide. Several types of fixation devices can be used for lumbar fusion.
Artificial ring, or artificial disk
You can prevent instability by inserting an artificial ring (cage) in the space between the vertebrae from which the disc has been removed. Since the spine is firmly fixed after surgery, you can walk immediately after surgery. You can also quickly return to work or social life after surgery.
Spinal screw fixation
If the spinal instability is severe, it is difficult to expect a sufficient fixation effect with the artificial ring. The spinal screw is used at this time. The best success rate can be achieved when spinal screw fixation is used with an artificial ring.
■ Prevention:
There is no way to prevent degenerative changes, which are aging according to age, but you can slow down the progress of degenerative changes when you are in normal posture and steady exercise.
■ To the doctor:
Frequent recurrent back pain.
When the back pain persists in spite of stability for a certain period.
If you need to take a rest for 30 minutes when you walk with pain in your legs
When paralysis of the toe or ankle occurs in back pain patient
When cattle and stool faults occur in patients with back pain
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