Objective: To observe the clinical effect of the treatment of lumbar spinal stenosis disease by adjusting the curvature of the spine based on orthopedic spinal therapy. Method: Curvature adjustments by four-direction, spinal orthopedic manipulation and functional exercise were applied to different patterns of lumbar spinal stenosis. Results: The overall response rate was 98.9%, including a clinical recovery rate of 83.3%, response rate of 13.3%, marked effectiveness rate of 2.2% and failure rate of 1.1%. The spinal curvatures were improved in 81% of the patients. The 3-month follow-up showed that the “excellent” and “very good” rates of the health status and signs & symptoms improvement were 98.8% and 96.4% respectively. Conclusion: The principal objective of curvature adjustment and Chinese orthopedic manipulation is to adjust the lumbar curvature. Functional exercise is positively correlated with restoration and stability of the spinal curvature. The follow-up indicates that regular exercise is essential to facilitate the therapeutic efficacy.
Lumbar spinal stenosis (LSS) is a medical condition in which the spinal canal narrows and compresses the nerve of the cauda equina or nerve roots at the level of the lumbar vertebra. This is usually due to the lumbar curvature disorder and then occurrence of spinal disc herniation, disc protruding into the spinal canal, or because of the rotational displacement of vertebral body, posterior longitudinal ligament and ligamentum flavum thickening and fold, and other reasons, resulting in 1 or more intervertebral disc area stenosis.
Between February 2009 and December 2009, we treated a total of 90 LSS cases and obtained satisfactory outcomes with spinal curvature adjustment by hyperextension suspension traction, spinal orthopedic manipulation, acupuncture, oral and external use of Chinese medicine. The results are now reported as follows:
Clinical Materials
General Material
Of the 90 LSS cases, the male/female ratio: 47/43, the age range: 22 - 75 years old, average age: 50; and the duration of disease: 1 - 414 months, average duration: 18 months. Of the 11 rejected cases, 9 failed to stick to the treatment after obvious alleviation of symptoms; 2 cases had slight adverse reactions, which disappeared after treatment and discontinued the treatment.
Diagnostic criteria were based on the “Lumbar Spine” [
1) Chronic progressive low back pain was accompanied with leg pain and weakness. Intermittent claudication or claudication needed help;
2) Localized leg dysesthesia or numbness were coupled with tendon reflex decrease and muscle weakness below grade 4; frequent or incontinent urination and weakness in passing stools;
3) Radiographic image showed over 2˚ of posterior-anterior (PA) rotation, over 5˚ of scoliosis, a smaller, disappeared or even reversed spinal curvature from the lateral view that could be classified as grade III, IV and V;
4) SEP femoral, tibia and fibular nerves were obviously extended (normal range: 42 - 50 ms);
5) CT scan showed that the transverse and sagittal diameters of the dural sac were ≤12 mm (normal transverse diameter: 13 - 21 mm; normal sagittal diameter: 12 - 16 mm);
6) MRI scan showed thickened ligamentum flavum and more than 3 intervertebral discs compressing the dural sac. The overall sagittal diameter of the dural sac was shortened by over 3 mm.
Meeting one of the above 1 - 3 and 4, 5, one could incorporate diagnostic criteria.
These include curvature adjustment, relaxing the tendons, spinal orthopedic manipulation and functional exercise.
Before curvature adjustment, all cases were treated with hot compression of medicine, needling technique (Jiaji Points) and tuina to relax the tendons.
After relaxing the tendons, choose rotation of the thoracic and lumbar vertebrae, rotation of the lumbar vertebrae and oblique pulling of the lumbosacral vertebrae of spinal orthopedic manipulation. For specific procedures of these manipulations, please refer to the “Spinal Orthopedics in Chinese Medicine” [
The prone position semi suspension double lower limbs hyperextension thoracic-lumbar vertebrae traction method (
Tendon relaxing manipulation and orthopedic curvature adjustment are both conducted once a day. Take one day off after 7 days of treatment.
To sit very belly back hyperextension practice exercises, each time for 20 - 50, two times a day.
Our research team set up a “100 points evaluation for LSS” according to the therapeutic efficacy criteria, signs, symptoms and imaging quantifications. Using calculated points as indexes, this evaluation contains 5 grades, namely recovery, basic recovery, alleviation, marked effectiveness and failure. Less than 5 points increase after treatment indicates failure; 5 - 10 points increase indicates marked effectiveness; 11 - 20 points increase indicates alleviation; 21 - 30 points increase indicates basic recovery; and 31 - 40 points increase indicates recovery. For cases with a relatively higher baseline, over 80 points in total indicates recovery.
Grade 0 (0 point): Paralysis and inability to stand.
Grade I (5 points): Ability to stand but need support to walk.
Grade II (10 points): Intermittent claudication, i.e., numbness, weakness, soreness, distension and pain of the lower limbs, needs rest after walking less than 100 meters.
Grade III (15 points): Intermittent claudication occurs after walking 100 - 500 meters.
Grade IV (20 points): Absence of obvious pain in the lower limbs and asymptomatic within 500 meters of walking.
Grade 0 (0 point): no sensation at all.
Grade I (1 point): presence of deep touch sensation.
Grade II (2 points): presence of pain sensation and some touch sensation.
Grade III (3 points): complete pain and touch sensations.
Grade IV (4 points): complete pain and touch sensations with an ability to identify different sensations in distant locations.
Grade V (5 points): normal sensation.
0: loss of lumbar movement or reluctant to move because of pain.
1: restricted lumbar movement with an approximately 60˚ of restricted range of motion.
3: restricted lumbar movement with tolerable pain and an approximately 30˚ - 60˚ of restricted range of motion.
4: slightly restricted lumbar movement with an approximately 10˚ - 30˚ of restricted range of motion.
5: almost normal lumbar movement.
0: absence of reflex or positive sign of straight leg raising test (<45˚).
5: decreased reflex or positive sign of straight leg raising test (45˚ - 60˚).
10: Presence of reflex or negative sign of straight leg raising test.
Grade 0 (0 point): Complete muscle paralysis and absence of muscle contraction through observation and palpation.
Grade I (2 points): Voluntary muscle contraction fails to move the joint.
Grade II (3 points): Muscle contraction can move the joint horizontally but fails to counteract the gravity.
Grade III (6 points): Voluntary joint movement during counteracting the gravity but fails to move with resistance.
Grade IV (8 points): Ability to move with major resistance but still weaker than normal.
Grade V (10 points): normal muscle power.
0: urine retention.
2: extremely difficulty in micturition, incontinence or dripping of urination.
3: difficulty or strain in micturition.
8: frequent and hesitant urination.
10: normal bladder function.
Grade V (0 point): the arch area: 0, minus or >38 cm2; appearance: reversed arch; arched upper part but straightened or extended lower part; lumbosacral shaft angle: <110˚ or >150˚.
Grade IV (5 points): the arch area: 0; appearance: straightened; 110˚ ≤ lumbosacral shaft angle < 120˚ or 145˚ < lumbosacral shaft angle ≤ 150˚.
Grade III (15 points): 0 < the arch area ≤ 16 cm2; appearance: markedly decreased or arched upper part with flexed lower part; 120˚ ≤ lumbosacral shaft angle < 125˚ or 140˚ < lumbosacral shaft angle ≤ 145˚.
Grade II (25 points): 16 cm2 < the arch area < 28 cm2; appearance: decreased; 125˚ ≤ lumbosacral shaft angle < 130˚or 135˚ < lumbosacral shaft angle ≤ 140˚.
Grade I (30 points): 28 cm2 ≤ the arch area ≤ 38 cm2; appearance: normal; 130˚ ≤ lumbosacral shaft angle ≤ 135˚.
0: >3 mm of the compressed spinal segment before treatment. After treatment, add 5 points for 1 mm increase. The maximum score is 10 points.
0: <5 mm (normal range: 5 - 7 mm) of the compressed lateral recess capacity before treatment. After treatment, add 5 points for 2 mm increase. The total score is 10 points (Note: use MRI or CT alternatively).
0: >60 ms.
5: 55 - 60 ms.
10: normal range: 42 - 50 ms.
The SPSS 13.0 version software was used for statistical analysis on the 100-point LSS and curvature evaluation, and the t-test was used for independent samples on a total of 90 cases. The p < 0.05 indicates a statistical significance.
The 100-point evaluation and curvature grading before and after treatment (
Non-parameter test on two independent samples using the statistical software has shown that there were statistical significances in both 100-point evaluation (t = −26.01, p < 0.01) and curvature grading (t = −14.34, p < 0.01) before and after treatment. In addition, the LSS signs, symptoms and curvature grading were all significantly increased after treatment.
After the four-direction traction for curvature adjustment in 90 LSS cases, the overall response rate was 98.9%, including a clinical recovery rate of 83.3%, response rate of 13.3%, marked effectiveness rate of 2.2% and failure rate of 1.1%. The spinal curvatures were improved in 81% of the patients. The 3-month follow-up showed that the “excellent” and “very good” rates of the health status and signs & symptoms improvement were 98.8% and 96.4% respectively. Clinical trials have proven that patients are willing to accept this safe reliable treatment technique.
A 35-year-old female patient first visited on April 15, 2010 because of “2 years of intermittent low back pain that aggravated and radiated numbness and pain in the left leg for over 4 months”. Her signs and symptoms: low back pain, especially the sensations of soreness and distension, restriction in rolling over the body, and an inability to bend or sit (no more than 5 minutes), stand (no more than 10 minutes) or walk (no more than 300 meters) for long period of time.
Other symptoms include: leg numbness radiating down to the toes, numbness around the anus and perineum, and cold intolerance below the waist. Physical examination showed that lumbar muscle stiffness with poor elasticity, tenderness along the bilateral sides of L4-S1, positive sign of straight leg raising test (left leg: 30˚; right leg: 50˚), decreased patellar tendon reflex on the left side, absence of Achilles tendon reflex on both sides, left- sided weakness by great toe dorsal extension test, grade III muscle strength of the left leg and grade IV of the right leg, decreased muscle tone on both legs, and atrophy of left-sided gluteal and leg muscles. The tongue was pale red with a thin white coating. The pulse was deep, thready and weak.
The lumbar MRI done on January 19, 2010 showed (see
Diagnosis: lumbar spinal stenosis.
The patient was treated with curvature adjustment using the “Four-direction orthopedic traction bed” (see
Item | Pre-treatment score | Post-treatment score | p value |
---|---|---|---|
Curvature | 11.61 ± 7.71 | 21.28 ± 6.64 | 0.00 |
100-point evaluation | 47.81 ± 11.52 | 78.53 ± 9.06 | 0.00 |
The main pathology of LSS lies in lumbar vertebral articular disorders and subsequent protruding of discs into the spinal canal, and buckling and thickening of the posterior longitudinal ligament and ligamentum flavum. This may further change the spinal curvature and narrow the spinal canal, intervertebral foramen and lateral recess, compressing the spinal cord and nerve root and leading to conduction disorders. Patients may present lower back pain and so on of a series of symptoms and signs. We believe that the human lumbar curvature is gradually formed with development since standing and walking at the age of 1 [
Through measurement on cross-sectional area of the psoas major muscle in normal volunteers and patients herniated lumbar discs, Dangeria, T.R. et al. [
Most LSS patients experience a smaller, disappeared or even reversed lumbar curvature. This is mainly due to injury, adhesion or atrophy of the psoas major muscle. Higuchi, K. et al. [
Curvature-adjustment orthopedic procedure mainly works on adjusting the spinal curvature, in other words, on restoring the biomechanical changes of the spine due to chronic strain-related rotation, tilting and scoliosis of the lumbar vertebral articulations. Functional exercise further helps to strengthen and facilitate the muscles and ligaments. Taken in this sense, exercise is a key supplementary method for curvature adjustment and also an essential measure to prevent relapse of LSS.
We are grateful to China’s state administration of traditional Chinese medicine project funding this research topic, and Chaozhou Central Hospital affiliated to Southern Medical University and Foshan Hospital of TCM Guangdong Province in observation of clinical cases in this paper.
Yizong Wei,Donghua Pan,Xiuguang Wang,Teng Gao,Shengqiang Zhang,Tingzhang Lin,Chunde Wei, (2015) Efficacy Report of Lumbar Spinal Stenosis of 90 Cases Based on Adjusting the Curvature of the Spine with Hyperextension Traction. Open Access Library Journal,02,1-8. doi: 10.4236/oalib.1101159