Spinal Stenosis Center

同行评审

现代管道是一种技术奇迹,但并非没有问题。随着时间的流逝,当您的管道墙壁被矿物质和……其他笨蛋涂覆时会发生什么?它阻碍了水流,并为整个系统造成了问题。

There are parts of your body where the same thing happens. In the arteries, the gunk that adheres to the artery walls is called plaque. If a piece of plaque breaks off, a blood clot may form around it and block blood flow to the heart or brain and boom. Heart attack or stroke. Bad news.

Something similar can happen within your spine. The spinal canal should have enough room for the spinal cord to travel the length of the spine. However, if that space narrows—usually due to a herniated disc or sometimes a bony overgrowth—nerve roots or the spinal cord itself can become compressed. The narrowing of the spinal canal is called stenosis, and it’s responsible for a huge number of back pain cases and conditions, including the dreaded sciatica.

脊柱狭窄是神经和脊髓的狭窄通道Spinal stenosis means a tight squeeze for your nerve roots or spinal cord.

Want to learn more about spinal stenosis, how it happens, its symptoms, and its treatments? You’ve come to the right place. Read on.

什么是脊柱狭窄?

A clue to answering this question is found in the meaning of each word.Spinalrefers to the spine.狭窄is a medical term used to describe a condition where a normal-size opening has become narrow. Spinal stenosis may affect the cervical (neck), thoracic (chest), or lumbar (lower back) spines.

最常见的部位是腰部旋转e followed by the cervical spine.

MRI L4-L5脊柱狭窄上面的轴向(头顶)MRI显示了L4-L5脊柱狭窄,并具有肉眼素的变性和增厚。有助于支撑脊柱的韧带。照片来源:Spineuniverse.com。
脊柱狭窄的插图狭窄is a medical term used to describe a condition where a normal-size opening has become narrow. Photo Source: 123RF.com.

可视化脊柱狭窄

Just like your home’s plumbing system, your spinal column has a number of passageways that need to be unimpeded for efficient flow. In the spine, the passageways are thespinal canaland theneuroforamen。Thespinal canalis a hollow vertical hole that contains the spinal cord (from the cervical spine down to the upper lumbar L1 level). Below L1, the spinal canal contains nerve roots for the motor and sensory function of lower extremities and bowel/bladder sphincters. Theneuroforamenare the passageways that are naturally created between the vertebrae through which spinal nerve roots exit the spinal canal.

椎体,标记的结构,颜色图

Theneuroforamenare the passageways that are naturally created between the vertebrae through which spinal nerve roots exit the spinal canal. Photo Source: SpineUniverse.com.


Illustration above:The spine's bony structures encase and protect the spinal cord. Small nerve roots shoot off from the spinal cord and exit the spinal canal through passageways called neuroforamen.

腰部(下背部)脊柱狭窄如下所示。注意脊柱管(红色区域)中的狭窄区域。随着运河空间的变窄,脊髓和附近的神经根部被挤压,导致不同类型的症状。医学术语是神经压缩

lumbar spinal stenosis

腰椎中央脊柱狭窄。照片提供:Spineuniverse.com。

Anatomy and Spinal Stenosis

The spine is a column of connected bones called vertebrae. There are 24 vertebrae in the spine, plus the sacrum and tailbone (coccyx).

在每个椎骨的背面(后部),您有薄片,这是一个保护您的脊髓和脊髓的骨板。您的椎骨还具有几个称为棘突过程的骨tab。这些过程是肌肉和韧带的附着点。

韧带连接并稳定椎骨。一种被称为韧带的特殊韧带,是脊柱狭窄的常见嫌疑人。当您坐下并向前倾斜时,韧带伸出了韧带,为您的脊柱管提供了更多的脊柱神经空间。但是,当您站起来并向后倾斜时,韧带的葡萄糖变短,更厚,这意味着脊柱神经的空间更少。这种动态能力有助于解释为什么患有脊柱狭窄的人会发现坐下比站立或步行更好。

In between each vertebra are tough fibrous shock-absorbing pads called the intervertebral discs. Each disc is made up of a tire-like outer band (annulus fibrosus) and a gel-like inner substance (nucleus pulposus).

The spinal cord, the thick bundle of nerves that extends downward from the brain, passes through a ring in each vertebra. Those rings line up into a channel called the spinal canal.

Between each vertebra, two nerves branch out of the spinal cord, one to the right and one to the left, through spaces called the foramen.

Normally, the spinal channel is wide enough for the spinal cord, and the foramen are wide enough for the nerve roots. But either or both can become narrowed, and cause spinal stenosis.

木椎骨切片;椎间盘理椎间盘的紧张神经In the overhead slice of a lumbar vertebra, the key anatomical structures are labeled, including causes of low back spinal stenosis: herniated disc and compressed nerves. Photo Source: Shutterstock.com.

Spinal Stenosis Signs and Symptoms

Typically, symptoms of stenosis progress over time. This is because nerves increasingly become more compressed, so minor signs of stenosis might eventually become more significant, and possibly chronic. For cervical or thoracic spinal stenosis in which the spinal cord is impinged (myelopathy), the symptom typically consist of balance and gait difficulty, clumsy or dexterity issues using the hands. Symptoms of lumbar stenosis can include:

  • Pain or difficulty walking (neurogenic claudication)
  • Weakness in the legs
  • Occasional or ongoing numbness and/or burning, particularly in the buttocks or legs
  • Lower back pain, especially while walking
  • Foot drop, when there’s difficulty lifting the front part of the foot

Sometimes, resting may help alleviate symptoms but they tend to return during movement.

脊柱狭窄引起的原因和危险因素

衰老是脊柱狭窄的最常见原因,这是由于脊柱管的正常变窄。根据美国骨科医师学会(AAOS)脊柱的退化性变化在50岁的人群中最多可见95%,脊柱狭窄最常发生在60岁以上的成年人中。这种病情同样影响男人和女性。

Although you can’t stop yourself from aging (we’ve tried), there are some factors that can raise your risk of developing stenosis, including:

  • Congenital and inherited issues, such as achondroplasia, which interferes with bone formation in the spine, and scoliosis, which can result from a genetic condition.
  • Arthritis conditions that affect the spine such asankylosing spondylitis,类风湿关节炎, and脊椎病(脊柱中的骨关节炎),这可能导致慢性炎症并负面影响椎骨之间的软骨,从而可能引起脊柱骨刺的生长。
  • Bone diseases likeosteoporosisand Paget’s disease, causing bones to weaken.
  • 损伤或肿瘤,例如骨折,椎间盘滑倒和异常组织生长,这可能都会施加脊柱神经的压力并影响骨骼健康。

The AAOS notes that among these factors, arthritis is the most prevalent for stenosis. With that condition, the body forms bone spurs to stabilize the joint and ligaments begin increasing in size. Both of those effects reduce the space for nerves, increasing risk of stenosis.

Spinal Stenosis Diagnosis and Tests

狭窄被诊断为一项检查,包括对病史的讨论,包括关节炎等任何疾病,以及imaging tests如:

  • 一般移动性:例如,可能会要求您向前或向前弯曲以确定疼痛的局限性或发作。
  • X射线: X-rays best depict hard tissue such as bone. They can show age-related changes like bone spurs or loss of disk volume, and you may be asked to have an X-ray taken while you lean forward. This may show instability in the joints.
  • Magnetic resonance imaging: An MRI will be able to provide images of soft tissues—including nerves, discs, ligaments, and more—that run through the spinal cord.
  • CT检查: CT scans can indicate damage or weakness in bones through a cross-section image of the spine.
  • Myelogram: This procedure uses contrast dye to highlight nerve pathways, which can help detect nerve compression.

Spinal Stenosis Treatment Options

与许多其他back painconditions, your treatment options will depend on the severity of your symptoms and how much they affect your quality of life. In general, however, if stenosis is diagnosed when there’s still fairly good mobility, the treatment will focus on alleviating symptoms.

First Line Treatment

物理治疗通常是recommended as a first step in stenosis treatment since this can help strengthen muscles—relieving pressure on the spine. Your doctor may also suggests stretching exercises and core strengthening to provide better flexibility and support for the spine.

Medications

由于疼痛是由脊髓神经的压力引起的,因此药物使用通常集中在减少炎症上。这可以通过对脊柱的可的松注射和/或非甾体类抗炎药(NSAIDS)进行疼痛缓解。

手术

If front-line treatments are ineffective or there is severe pain and loss of mobility, surgery may be an option. The patients with cervical or thoracic myelopathy due to spinal canal stenosis typically have neurologic deficits with numbness, weakness, and gait imbalance, and therefore, surgery should be considered earlier than later to prevent permanent nerve damage.

治疗宫颈或胸椎狭窄的手术技术包括宫颈椎板成形术,宫颈椎板切除术和融合,前宫颈椎间盘切除术和融合,前宫颈切除术和融合,胸椎切除术,胸腔解压缩和融合等。

Procedures used to treat lumbar stenosis include:

  • Laminectomy。This removes the lamina of the affected vertebra. Sometimes called decompression surgery, this is meant to ease pressure on the nerves by creating more space for them. In some cases with associated instability or deformity of the spine such as spondylolisthesis or scoliosis, a laminectomy will include a spinal fusion, when a vertebra is attached to adjoining bone to maintain support in the spine.
  • Laminotomy and Foramintomy。在此过程中,仅除去了一部分薄片和刻面关节,只有一个小孔才能使神经更多的空间。

Home Remedies for Spinal Stenosis

In addition to front-line treatment, there are some home care strategies and complementary therapies that may reduce symptoms:

  • 针灸和按摩
  • Gentle yoga or Tai Chi
  • Heat therapy with a heating pad or warm towel to relax muscles
  • Cold therapy with cold pack to relieve swelling and pain

Complications of Spinal Stenosis

根据Mayo Clinic, many of the surgeries for spinal stenosis help reduce symptoms, but that’s not always the case. Some people may find their symptoms stay the same or even worsen after surgery. Also, risks can include感染, a tear in themembrane covering the spinal cord, a blood clot in the leg vein, and potential neurological deterioration.

Any time you have surgery there is a small risk of complications, but doing nothing may be no better. Difficulties from untreated spinal stenosis can include:

  • Numbness and weakness
  • Balance problems
  • Incontinence
  • Paralysis

脊柱狭窄何时严重?

If you have loss of mobility, debilitating pain, or disruption of everyday life, thenstenosis may be serious

One other sign that’s considered significant but rare is numbness in your genital region with loss of control in the bowel or bladder. This is called acutecauda equina syndrome, and is considered a medical emergency.

What Is the Long Term Outlook for Spinal Stenosis?

减少症状和slo与适当的治疗w progression, you can often manage spinal stenosis. However, you may need to adjust your type of physical activity, and keep on top of inflammation and pain management to ensure that you maintain a high degree of mobility.

来源

AAOS. “Lumbar Spinal Stenosis.”https://orthoinfo.aaos.org/en/diseases-conditions/lumbar-spinal-stenosis/

Mayo Clinic. “Spinal Stenosis.”https://www.mayoclinic.org/diseases-conditions/spinal-stenosis/diagnosis-treatment/drc-20352966

Johns Hopkins Medicine. “Foraminotomy.”https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/foraminotomy

新英格兰医学杂志。(2008年。)“腰椎狭窄的手术与非手术疗法。”https://www.nejm.org/doi/full/10.1056/nejmoa0707136

Updated on: 09/20/21

Related Articles

Howard S. An, MD
骨科手术教授
拉什大学医学中心
Chicago, IL
×
SHOW MAIN MENU
SHOW SUB MENU
取消
删除
继续阅读:

Spinal Stenosis: Lumbar and Cervical

Spinal stenosis compresses the spine's nerves and/or spinal cord. Lumbar spinal stenosis affects the low back and cervical spinal stenosis causes symptoms in the neck. Back or neck pain is the foremost symptom.
Read More
Baidu