Spinal
stenosis is a disorder of the spinal column that typically occurs in the
cervical or lumbar vertebrae. This paper will discuss the signs, symptoms and
treatment options for lumbar spinal stenosis. Pain, numbness or weakness of the
legs occurs due to a narrowing of the spinal canal, which in turn puts pressure
on the spinal cord and surrounding nerve roots. Symptoms may also present
mimicking sciatica if the sciatic nerve is impinged. It is characterized as a
degenerative disease, and for this reason, usually seen in people over fifty
years of age. Of course, people who are born with back problems may develop
signs and symptoms earlier (1).
From
a western point of view, two common causes of spinal stenosis are arthritis in
the joints, and increased size in the ligaments surrounding the joints.
Arthritis happens as the discs between the vertebrae lose moisture and begin to
collapse, decreasing the space between the vertebrae. This upsets the balance
of the spinal column as the weight transfers to the facet joints, and also
decreases the space in the foramen where the nerves exit. Over time, the facet
joints wear out their protective cartilage and the body will grow new bone
(bone spurs) where the cartilage was to support the vertebral column. All of
this leads to a narrowing of the spaces where the nerves pass through.
Typically, leaning forward will alleviate symptoms, as it increases the space
between the facet joints, and standing upright or walking long distances will aggravate
the pain (1).
Western
doctors can perform a number of tests to get a better idea of what exactly is
going on. An X-ray will show if there is a degeneration of vertebral discs or
bone spurs. An MRI will make it possible to view the surrounding soft tissues
as well as the nerves and spinal cord. A CT scan will show if a nerve root is
being compressed. Based on these results, the doctor may suggest cortisone
injections to decrease the swelling and pain around the joint. However, this
will not help with the weakness in the legs and it is inadvisable to have these
injections more than three times per year. The may suggest chiropractic
manipulation, physical therapy, lumbar traction, NSAIDs or surgery. There are
two surgical options; the first being laminectomy and the second being spinal
fusion. During a laminectomy the doctor will remove bone, bone spurs or
ligaments that are pressing on the nerves. During a spinal fusion, the
arthritic joints between the vertebrae are permanently fused together to
prevent further degeneration (1).
In
Chinese Medicine, typical patterns for back pain can be seen as Kidney essence
or Qi Xu, Qi and Xue Stagnation, or Bi syndrome (2). Being that the Kidney’s
govern bone, when bone spurs occur there is a Xu of Kidney Qi. If there are
congenital back problems, in TCM it could be seen as a Kidney essence Xu.
Trauma to the area or strain to the area over time (over lifting or improper
lifting of heavy objects) can lead to local Qi and Xue Stagnation. Likewise,
and invasion of Wind Cold Damp can get lodged in the area creating inflammation
and pain.
For
a treatment I would focus on points to nourish the Kidneys, Liver and Spleen such
as KD3, LV8, SP6, SP10, ST36, BL18, BL21, and Ren 6. I would add points to move
Qi and Xue such as LI4 and LV3, as well as open the DU: DU60 and SI3 and I
would do warming techniques, such as Moxa, on DU4 and BL23. I would also
consider electro stimulation from the most reactive Hua Tuo’s in the lumbar
joints to BL40 to open up the lower back.
Du
Huo Ji Sheng Tang is the standard formula for eliminating wind dampness with an
underlying Qi and Xue Xu. I would try this formula first if the patient presented
with clear Bi syndrome symptoms, such as symptoms are affected by weather
changes. Predominantly, though, I would focus a formula on building the Kidneys,
such as Jin Gui Shen Qi Wan to nourish Kidney Qi and Essence. I would consider
adding Chuan Xiong or Ji Xue Teng to move stagnation as well as Du Huo to guide
the action to the lower half of the body.
