How to treat lumbar disc stenosis

Lumbar disc stenosis is also known as spinal canal stenosis. Due to certain causes, the path of the spinal canal is shortened, which can easily compress the dura mater sac and cause damage to the nerve roots. It often causes patients to experience limb weakness, numbness of the lower limbs, radiating pain, etc. It can also cause patients to limp and cause urinary and bowel disorders, etc. At this time, appropriate methods should be used in a timely manner for treatment.

1. Non-surgical treatment

Non-surgical treatment is mainly suitable for:

① Young patients, first-time patients or patients with a short course of illness;

② Those whose symptoms are mild and can be relieved by themselves after rest;

③ Imaging examination showed no obvious spinal stenosis.

(1) Absolute bed rest: When the disease first occurs, you should strictly rest in bed, and emphasize that you should not get out of bed or sit up to urinate or defecate. This will achieve better results. After 3 weeks of bed rest, you can get up and move around while wearing a waist belt for protection, and do not bend over or hold objects for 3 months. This method is simple and effective, but difficult to stick to. After remission, you should strengthen your back muscle exercises to reduce the chance of recurrence.

(2) Traction therapy uses pelvic traction to increase the width of the intervertebral space, reduce the intradiscal pressure, retract the protruding disc, and reduce stimulation and compression on the nerve roots. It needs to be performed under the guidance of a professional doctor.

(3) Physical therapy and massage can relieve muscle spasms and reduce pressure in the intervertebral disc, but be aware that violent massage can aggravate the condition and should be used with caution.

(4) Corticosteroids Epidural injection of corticosteroids is a long-acting anti-inflammatory agent that can reduce inflammation and adhesions around nerve roots. Generally, long-acting corticosteroid preparations + 2% lidocaine are used for epidural injection.

(5) Chemical nucleus pulposus dissolution uses collagenase or papain, which is injected into the intervertebral disc or between the dura mater and the protruding nucleus pulposus to selectively dissolve the nucleus pulposus and annulus fibrosus without damaging the nerve roots, thereby reducing the pressure in the intervertebral disc or reducing the size of the protruding nucleus pulposus, thereby alleviating symptoms. However, this method carries the risk of allergic reactions.

2. Surgery

(1) Indications for surgery

① Patients with a medical history of more than three months, who have not responded to strict conservative treatment or who have responded to conservative treatment but have frequent relapses and severe pain;

② The first attack, but the pain is severe, especially in the lower limbs, and the patient has difficulty moving and sleeping, and is in a forced position;

③Combined with cauda equina compression;

④ Single nerve root paralysis occurs, accompanied by muscle atrophy and decreased muscle strength;

⑤Those with combined spinal stenosis.

(2) Surgical method: Through a posterior lumbar incision, partial resection of the lamina and articular processes, or intervertebral disc resection through the interlaminar space. For central disc herniation, laminectomy is performed followed by epidural or intradural discectomy. Patients with lumbar instability and lumbar spinal stenosis require spinal fusion surgery at the same time.

In recent years, minimally invasive surgical techniques such as microdiscectomy, microendoscopic discectomy, and percutaneous transforaminal endoscopic discectomy have reduced surgical damage and achieved good results.