Name: Wang Rui

Sex: Female

Age: 52

Symptoms: Right part of waist and back hurts intermittent and transferred to the right leg for about 5 months, even heavier.

History of present illness: 5 months ago, the patient got intermittent swelling pain in her right part of the waist for no obvious reason. Then, her right foot hurt, too. It got more heavily after walk and doing sports. But it got spontaneous remission after have a rest. Nearly a week, it got heavily and had no obvious signs of improvement. Lumbar MRI examination showed that the L5S1 of lumbar had disc herniation, lumbar spinal canal stenosis, L1-L5 lumbar bone hyperplasia. For further diagnosis and treatment, she came to Sun-good Hospital. Since the morbidity of the patient, she got severe pain, poor sleep and diet but got normal urine and no significant change in body weight.

Nervous system: See the orthopaedic situation

Department of orthopedics situation: Natural twisted spine turns straight but it bends towards left slightly. Spinal flexion and extension was limited. L5-S1 spinous clearance had mild tenderness, right hip had obvious tenderness, right leg had radiating pain, right side of the anterior leg had tingling, right Achilles tendon and right toes had a weak sensory reflex, two ankles and left toe had normal extension muscle strength. Because of the postural changes, patient got pain. Straight leg raising test positive, piriformis muscular tension test positive, limbdorsalis pedis artery had powerful putsation, temperature of skin was normal, nail bed was good.

TCM syndrome differentiation: female patient, 52 years old, is worn out with age and has deficiency of kidney essence, waist pain. kidney main bone marrow of Health, kidney essence deficiency, and after walking and doing activities, pain aggravates but it relieves after having a rest, white tongue, thin pulse are all symptoms of d eficiency of kidney-essence.

Auxiliary examination: Lumbar MRI （2009-12-10）, L5-S1 lumbar disc protrusion; lumbar intervertebral disc herniation, Lumbar spinal stenosis, L1-L5 Lumbar bone hyperplasia.

Diagnosis of TCM: Lumbago-kidney essence deficiency type

Western medicine diagnosis:1.Prolapse of lumbar intervertebral disc

(L5-S1)

2.Lumbar spinal canal stenosis

3.Lumbar bone hyperplasia (L1-L5)

Therapies: Take acupuncture as treatment to treat degeneration of soft tissue injury and minimally invasive treatment of acupuncture and medicine in treating the central type of prolapse of lumbar intervertebral disc, lumbar spinal canal stenosis

Advantages: 1.Safe: Because of less acupuncture points, precision medicine and no pain. Also, doctors treat patients with TCM so injury can be avoided.

                   2.Quick: Rapid recovery; Patients can walk after treatment and they can go back to work normally a                         few days later. For lumbocrural pain, they can be relieved once treating; Avoid adhesion after operation

Indication: 1.The first fall sick of patients who have got lumbar disc herniation; lower limbs get extreme pain, insomnia; patients have difficulty in walking and patients who don’t get  ideal conservative treatment.

                 2. Patients who have already take effective conservative treatment but it gets recurrent attacks; patients who have severe symptoms and also affect their life and work; patients who got this kind of disease for more than half a year; patients who need operation.

                 3. Patients who have central herniation of intervertebral disc associated with lumbar spinal stenosis; patients whose CT shows intervertebral disc calcification and OPLL.

1.  Lumbar disc herniation and spinal canal stenosis can be often seen in clinical practice and spinal stenosis itself can cause intractable sciatica symptoms.

2. Bone hyperplasia stenosis

 That patients over 40 years old get different degrees of stenosis of the canal can be often seen in clinical because of degeneration of the cervical, lumbar intervertebral disc and vertebral bone hyperplasia. That cervical thoracic duct stenosis oppress spinal cord and lumbar spinal stenosis oppress local dura can cause clinical symptoms of lower limbs.

3. Instability spinal stenosis

 Patients who get cervical and lumbar instability are mostly middled-aged people, due to intervertebral disc, ligament and joint capsule and other tissue degeneration or damage. Younger patients may get cervical and lumbar subluxation because of trauma. A minority of patients get adjacent vertebral instability because of compensatory activity increasing the formation of spinal stenosis area after having cervical lumbar surgery. While for those severe patients, their neck extension activities are often limited, some accompanied by numbness, leg muscle twitching, which are all the symptoms of spinal cord pathology oppressed.

4. OPLL

  Behind the vertebral, there’s  posterior longitudinal ligament. After it gets calcification, it makes the anteroposterior diameter of the spinal canal stenosis due to volume increases.

5. Developmental spinal stenosis

  Because of developmental factors, volume of each spinal stenosis is narrower than the normal. It can oppress  the spinal cord, nerve roots, dura-hsiang directly and  the dominant part of the soft tissue of the sympathetic nerve fibers are also likely to be oppressed so that vasospasm is more easily caused. Developmental cervical spinal stenosis is a major factor in causing cervical myelopathy.

Patients at their youth although get developmental spinal stenosis, but not the symptoms, adulthood, around vertebral degeneration, there may be some of the symptoms.

6. Symptoms of lumbar spinal stenosis

  The main symptom are a long-term back pain, leg pain, intermittent claudication. Patients often complain of lower lumbar and sacral pain and get weight when standing and walking, sitting or lateral light when hip flexor. Ministry of leg pain due to lumbosacral nerve root compression caused, often involving both sides of the disc were lighter than the cough is often not increased. Cauda equina intermittent claudication, but quiet and silent, a short walk from the perception of weakness and low back pain occurs only disappear when quiet after (neutral or squatting) then the symptoms disappeared. Quiet can be no positive findings on physical examination, straight leg raising test were negative, but in a relatively narrow with bulging disc, could be positive (about 80%).

7. Treatment of spinal stenosis

  Spinal stenosis has two kinds of treatment including surgery and conservative treatment. General developmental spinal stenosis, disc soft prominent spinal stenosis surgery patients that do not reach the level of taking operation may be considered non-surgical treatment. Bony spinal canal stenosis, acute trauma, spinal stenosis reach about half the level of taking operation, surgery may be considered.