The root of "intermittent claudication" may be in the waist!
Intermittent claudication is mainly based on the existing stenosis of lumbar spinal canal, and the pressure load of vertebral body and nerve root increases when standing upright. In addition, the relaxation and contraction activities of lower limb muscles further promote the physiological congestion of nerve root vessels of the corresponding spinal ganglia in the spinal canal, and then pull the venous blood stasis and nerve roots, so that the microcirculation of the corresponding parts is blocked, leading to ischemic radiculitis, resulting in waist and leg pain, numbness and weakness of lower limbs and other symptoms. When the patient squats, sits down or lies down to rest, the pressure load of nerve roots is reduced, the stimulus source during muscle activity is eliminated, and the ischemic state of spinal cord and nerve roots is improved, so the symptoms are also alleviated and disappeared. When walking again, the above symptoms reappear, and then rest, and the symptoms are relieved again, and so on, forming intermittent claudication. This is one of the main clinical features of lumbar spinal stenosis.
Lumbar spinal stenosis is a common disease in orthopedics, and its etiology is very complicated, including congenital lumbar spinal stenosis and secondary lumbar spinal stenosis. Secondary lumbar spinal stenosis is caused by degeneration or slippage of intervertebral discs and joints, traumatic fracture and dislocation, and deformed osteitis. Degenerative spinal stenosis is the most common.
In addition to lumbar spinal stenosis, intermittent claudication may also be caused by arterial diseases of lower limbs. How to identify?
Lumbar spinal stenosis is characterized by neurological intermittent claudication, which is different from vascular intermittent claudication (such as thromboangiitis obliterans).
1. Nervous intermittent claudication pulse of dorsal foot artery is good, while vascular intermittent claudication pulse of dorsal foot artery is weak or disappeared.
2. Neurotic intermittent claudication can cause segmental sensory disturbance of lower limbs, while vascular intermittent claudication is sock-like sensory disturbance.
3. The walking distance of neurotic intermittent claudication is gradually shortened with the extension of the course of disease, while vascular intermittent claudication is not obvious.
4. Arteriography is feasible when necessary. Intermittent claudication of nerves has good arteries, and intermittent claudication of blood vessels can show the narrow area of arterial cavity.
How to treat intermittent claudication caused by lumbar spinal stenosis?
1. Conservative therapy
Most patients with lumbar spinal stenosis can get obvious relief after conservative treatment. The method comprises the following steps:
(1) generally lie on your side with your hips bent and knees rested for 3 ~ 5 weeks, and the symptoms can be alleviated or disappeared. Long-term bed rest for the elderly is easy to cause complications such as muscle atrophy, deep vein thrombosis and pneumonia, and it is recommended not to exceed 2 ~ 3 weeks.
(2) Drug therapy: giving appropriate amount of non-steroidal anti-inflammatory drugs.
(3) Functional exercise: Lumbar flexion can increase the capacity and effective cross-sectional area of spinal canal, and reduce the compression on cauda equina. The enhancement of abdominal muscle strength can also resist the mechanical pressure of spinal canal on nerve tissue.
(4) Application of brace: Waist circumference (or lumbar protective support) can reduce the dynamic traction and compression of cauda equina nerve roots by articular processes and intervertebral discs during spinal movement. But it is not suitable for long-term application, so as not to cause muscle atrophy.
(5) Epidural administration: Injection of steroid drugs can play a local anti-inflammatory role. Some patients temporarily relieve pain, but it may aggravate or paralyze. Multiple injections will cause nerve adhesion and increase the difficulty of surgery.
(6) Others: traction, partial sealing, acupuncture, massage, etc.
2. Surgical therapy
If conservative treatment is ineffective for 3 months, the symptoms of consciousness are obviously and continuously aggravated, affecting normal life and work, or there is obvious nerve root pain and definite nerve function damage, especially serious cauda equina nerve damage, or lumbar spondylolisthesis and scoliosis are gradually aggravated, accompanied by corresponding clinical symptoms, surgery is needed.