Together outside the sacral canal injection needle-knife lysis treatment of lumbar

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To investigate the sacral canal injection of drugs combined needle knife outside the lysis treatment of lumbar vertebral canal stenosis of the clinical efficacy. [Method] 80 patients meet the diagnostic criteria for lumbar spinal stenosis patients, the use of drugs sacral vertebral canal injection with the needle knife outside the lysis treatment. [Results] one course of treatment, the cure in 28 cases, effective in 37 cases, markedly effective rate was 81.2%. [Conclusion] The lumbar spinal stenosis cure should choose safe, simple injection of the sacral canal with the needle knife outside of vertebral lysis.
[Keywords:] lumbar spinal stenosis; sacral canal; small needle-knife; combination therapy

Abstract: [Objective] To observe the clinical effect of canales sacralis injection and extra  vertebra needle  knife loosing on lumbar spinal stenosis. [Method] Apply medicinal canales sacralis injection combined with extra  vertebra needle  knife loosing to 80 cases, 1 time / w, 2 times as a course; appraise the cure effect after 1 course. [Result] 28 cases were cured, 37 had marked effect, and the effective rate was 81.2%. [Conclusion] Lumbar spinal stenosis treatment shall choose safe and simple canales sacralis injection and extra  vertebra needle  knife loosing.

Keywords:: lumbar spinal stenosis; canales sacralis; small needle  knife; combination treatment

Lumbar spinal stenosis is caused by a variety of reasons the spinal canal, nerve root canal stenosis and other diseases caused by nerve compression. The author from 2006 to 2007 the use of sacral vertebral canal injection with the needle knife outside the lysis treatment of lumbar spinal stenosis, 80 cases achieved good effect, the report is as follows.

A clinical data
1.1 General information on this group a total of 80 cases, male 48 cases, female 32 cases; aged 40 to 76 years, an average of 53 years of age; course of 2 months to 15 years. In which 66 cases of neural intermittent claudication, accounting for 82.5%. 42 cases of primary spinal canal stenosis, lateral recess stenosis in 15 cases, the primary spinal canal and lateral recess stenosis were 13 cases; lumbar disc herniation 16 cases caused by spinal stenosis, laminectomy, the upper and lower articular process and the posterior margin of bone hyperplasia 49 cases caused by spinal stenosis, hypertrophy of ligamentum flavum caused by spinal stenosis in 16 cases; onset segments: L5  S1 32 Li, L4  L5 38 cases, two are narrow in 10 cases.

1.2 diagnostic criteria for selection of 80 cases of lumbar spinal stenosis spinal stenosis CT consistent with the above diagnostic criteria, refer to 'treatment of bone injuries card specification' [3] the standard selection of cases: ① age above 40 years old; ② repeated low back pain with intermittent claudication; ③ most of the obvious signs, some patients may have spinal scoliosis, physical before the sudden decrease in lower extremity sensory disturbances, slow tendon reflexes, as well as reduced muscle strength and muscle atrophy.

Two treatment
2.1 in patients with vertebral lysis needle knife outside the prone position, belly pad 15cm mats. In the Department of lumbosacral and lower extremity tenderness point search sensitivity, according to imaging examination in the corresponding spine, the spine next to the set into the needle-knife point, gentian violet marking, skin routine disinfection. Operation method:

① lumbosacral: a. interspinous ligament: lesion interbody take place after needle-knife parallel to the midline, perpendicular to the skin piercing through the spine ligament, the mouth-line turned around the direction of needle-knife to make vertical After being in the middle, cutting, stripping lysis interspinous ligament. b. spine side: 1.5 ~ 3cm spinous process at the side opening into the needle-knife for the point, after the needle-knife parallel to the midline, perpendicular to the surface of the skin piercing, groping to the transverse process bone surface, loosening transverse attached muscles, tendons membrane.

② lower limb parts: a. hip tenderness points: needle-knife perpendicular to the surface of the skin piercing, for hard nodules, tilting to cut cord loosen and postoperative pressure 1min. b. to stimulate the lower leg lateral tenderness point: take tender points, needle-knife parallel to the body axis, perpendicular to the surface of the skin piercing, vertical clear peeling, and then reverse the knife-edge, cross-cutting look at, not too deep, feeling men loose dynamic, a needle-knife. Releasable needle knife 1 week, 2 times for a course of treatment.

2.2 sacral canal injecting drug use triamcinolone-A needle 20mg, 2% lidocaine needle 5ml, Methycobal needle 100ug, anisodamine needle 10mg, plus normal saline to 20ml. Operation Methods: prone position, belly pad 15cm mats, fully reveal the sacral, routine disinfection of shop towels, with sterile gloves.

Angle between the sacrum in two hit shall be an elasticity of depression sacral hiatus, patients will be first-hand corner of the thumb pressure in the sacrum, the other hand the needle on the 7th at the sacral hiatus, inclined 30 ° pierce the skin, when the thorns off sacrococcygeal ligament when a sense of frustration that the needle has entered the sacral cavity, suction without cerebrospinal fluid, blood, injected into the air and then slowly drag-free injection, injection should be no resistance or a slight resistance, first slowly into 5ml, observation 2min, such as the No lumbar epidural anesthesia and other symptoms confirmed that no damage, the remaining liquid will be injected into the sacral canal in 1min. At this point most of v. disease in patients with leg Suanzhang flu, after needle injection pinhole covered with sterile gauze, so that patients with supine 10min. Weekly injection of 1, 2 times for a course of treatment.

3 Results
Efficacy Standard: cure: low back pain disappeared, intermittent claudication disappeared, muscle strength returned to normal, resume normal work. Markedly effective: pain completely disappeared, intermittent claudication disappeared, slightly lower limb numbness, muscle strength to restore near normal. Improved: low back pain reduced, when intermittent claudication, numbness, and muscle weakening slightly improved. Invalid: no change before and after treatment, or even increase. Treatment Results: After one course of treatment cured 28 cases, effective in 37 cases, improvement in 14 cases, ineffective in 1 case, markedly effective rate was 81.2%.

4 Discussion
Of lumbar spinal canal stenosis caused by the principle of low back pain was mainly due to the oppression of lumbar spinal canal stenosis caused by micro-veins and capillaries, stasis, metabolic products accumulate in the nerve tissue caused the inflammatory pain [4], such a lesion caused by muscular tension and muscle spasm make the mechanical imbalances within and outside the spinal canal to induce vertebral soft tissue outside the lesions, aseptic inflammation, nerve compression, nerve pairs of cards, a variety of pathological conditions [5], causing low back pain, intermittent claudication and a series of symptoms.

Needle knife outside the vertebral purpose of loosening loosen adhesion, except for pathological factors, to restore the mechanical balance of the spine. In the waist cutting, stripping interspinous ligament, sacral spine muscles intertransverse muscles intertransverse ligament and other soft tissue lesions, eliminating aseptic inflammation, muscle cramps and muscle tension to lift and restore spinal balance.

Hard nodules on the buttocks, cutting cord membranes by lysis can be alleviated by local muscle spasm, relieve nervous tension and edema [6]. Sensitive point tenderness in the lower limbs to stimulate the line of needle-knife, can lift the lower limbs due to pain caused by posterolateral muscle tension, pass through the vibrant, Regulating blood, eliminating the symptoms. Drugs into the epidural space through the sacral canal, a direct effect on the nerve root and spinal cord, so that lysis adhesions around the nerve root to relieve nerve root compression, nerve root block the vicious cycle of ischemia and hypoxia, promote local blood circulation to promote the absorption of inflammatory substances, which serve to eliminate inflammation, relieve pain purposes.

Triamcinolone A can reduce the capillary permeability, reduce edema, inhibit inflammatory infiltration and leakage, to prevent the inflammatory adhesion of both phases of the role of inflammation, along with lower cell membrane permeability, reducing autoimmune response role. Methycobal can improve the nutritional and functional status of nerves.

Low concentrations of lidocaine can block nerve conduction, played the role of local anesthesia, but also speed up the excretion of metabolites in inflammation and edema of the absorption and dissipation. Anisodamine can expand blood vessels, improve microcirculation. This amount of hormone mixture quickly into the epidural space, but also through the epidural space to the direction of the proliferation of intervertebral foramen, separating nerve root adhesion, which causes the intervertebral space and nerve root canal expansion, strengthening the parts of the liquid in the inflammation proliferation, so as to achieve the purpose of anti-inflammatory pain.

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