Don't be afraid of spinal stenosis, there are ways to prevent and treat it

Author: Wang Xiaohui, Jiang Chao, Zhang Yongyuan, Xi'an Jiaotong University Affiliated Red Cross Hospital

Illustration: Wang Xiaohui, Red Cross Hospital Affiliated to Xi'an Jiaotong University

Reviewer: Hao Dingjun, Chief Physician, Red Cross Hospital Affiliated to Xi'an Jiaotong University

Spinal stenosis is an abnormal narrowing of the spinal canal or nerve root canal, which can cause compression of the spinal cord or nerve roots. Symptoms include limb pain, numbness, weakness, etc., which gradually worsen with the development of pathological structures in the spinal canal. Before treatment is needed, patients can undergo some conservative treatment in the early stage. The gradual narrowing of the spinal canal will aggravate the symptoms of spinal cord compression in the corresponding area, and medical treatment is required in severe cases.

The causes of spinal stenosis include degeneration, hyperplasia of the ligamentum flavum, ossification of the posterior longitudinal ligament, tumors, and trauma. In addition to pain, patients also experience stiffness in the neck, chest, and waist muscles and numbness in the limbs. Although spinal stenosis cannot be cured, the following treatment suggestions can help patients control and relieve symptoms.

1. Physical Exercise

One of the most effective conservative treatments for spinal stenosis is regular physical exercise. Patients can do it on their own, but it is recommended to do it with the help of a physical therapist or rehabilitation physician, who will standardize the movements of various exercises according to the patient's physical condition and needs. This type of exercise mainly focuses on strength, flexibility and balance exercises, which can effectively relieve pain and reduce the impact on the patient's daily life.

Balance training can be achieved with tools such as fitness balls and wobble boards, and such training can also strengthen the patient's core muscles. Patients can also improve the strength and flexibility of the entire back muscle chain through crunches, leg lifts, and small swallow flying movements. The advantage of professional guidance for patient training is that they can ensure that patients do not exceed their own exercise limits (for example, they will not recommend patients to do large-scale stretching and flexion movements on their own, such as yoga, etc.), because excessive stretching or flexion will aggravate the symptoms of spinal stenosis.

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2. Use assistive devices

When the symptoms of spinal stenosis become more severe, patients may have difficulty walking or even standing. In this case, it is necessary to consider using assistive devices to improve movement disorders. Depending on the degree of movement disorders, devices of different functional strengths can be selected, such as braces (cervical, back, lumbar), crutches, or walkers. If the pain episodes affect the patient's daily activities, the use of these devices may be necessary.

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The most commonly used brace for patients is the back brace, which provides strong support to the back muscles and spine while allowing the patient to stand more comfortably. When the back is supported, the paraspinal muscles can be relaxed, the patient's movement can be more stable, and pain can be relieved.

In addition, if the patient suffers from diseases that affect the function of the lower limbs, such as hip and knee arthritis, their movements will be more unstable, and these assistive devices can play a supporting and corrective role in the lower limbs. Walkers are specially designed for patients with movement disorders to maintain stability and balance while walking.

3. Surgical Intervention

If spinal stenosis has developed to the point where the patient has great difficulty walking, or has already developed urinary and bowel problems, surgical treatment should be considered. The main causes of spinal stenosis are degeneration, hypertrophy of the yellow ligament, ossification of the posterior longitudinal ligament, etc. Depending on these different causes, doctors will adopt different surgical plans.

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Taking cervical spinal stenosis as an example, the most common surgeries for treating spinal stenosis are laminoplasty and laminectomy. Both of these surgical methods release space in the spinal canal to "rescue" the compressed nerves from the narrow spinal canal. Due to surgical risks, patients have the right to know the expected results and the recovery time required for the surgery before choosing the surgery. In addition, there are other surgeries for treating spinal stenosis, such as foraminotomy, anterior cervical discectomy, bone grafting, fusion and internal fixation.

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4. Muscle relaxant drug treatment

For patients with spinal stenosis, muscle relaxants need to be used in combination with the specific condition. The narrow spinal canal can compress the patient's spinal cord, further causing the muscles innervated by the spinal nerves (such as the brachial plexus) to lose normal neural regulation, resulting in sudden and uncontrolled contractions, called muscle spasms. When other treatments cannot relieve symptoms, muscle relaxants can be used to relieve muscle spasms caused by spinal cord compression.

When a patient has muscle spasms, the muscle tension of the corresponding segment of the compressed spinal cord will be very high and the movement will be limited. Taking muscle relaxants as prescribed by the doctor can relieve symptoms in a short time. It is necessary to pay attention to the adverse reactions of taking these drugs, such as dizziness, fatigue, depression, low blood pressure, etc.

5. Analgesic drug treatment

When symptoms of spinal stenosis occur, taking pain medication is the most direct way. Patients can buy low-dose over-the-counter medications to relieve less severe pain. For patients with very severe pain symptoms, a spinal surgeon may prescribe a stronger prescription pain medication.

Common analgesics include celecoxib, nimesulide, etc. Pain is the most common symptom of spinal stenosis, and these drugs can effectively relieve the pain caused by pain. Patients should also be aware of the adverse reactions of the drug before taking it to ensure safe use of the drug.

6. Drugs that improve microcirculation and nourish nerves

Spinal stenosis compresses the nerves and causes blood circulation disorders in the cervical and lumbar nerve tissues, leading to long-term recurrent neck/low back pain and muscle weakness. Oral administration of some drugs that improve blood microcirculation can also effectively relieve the clinical symptoms of spinal stenosis, such as prostaglandin E, alprostadil, etc., which can effectively improve peripheral circulation disorders, increase blood flow to nerve tissues, improve pain hypersensitivity, and improve nerve function. In addition, you can also take nerve nourishing drugs such as methylcobalamin or vitamin B1 under the doctor's advice to maintain and protect nerve function.