Outline:  
Spinal canal stenosis of lumbar vertebrae is a clinical syndrome due to compression of cauda equina and nerve root, which results from deformity or narrowing of lumbospinal canal, nerve root canal and intervertebral foramen caused by many factors. According to its causative factors, it may be classified into congenital (developmental) and secondary types. It mostly occurs in middle-aged and old people. The predilection site is between the fourth and the fifth lumbar vertebrae followed by between the fifth lumbar and the first sacral vertebrae.

Congenital maldevelopment of spinal canal and degeneration of lumbospinal vertebrae in the middle-aged and older, what is more, hyperosteogeny, thickening of yellow ligament and vertebral lamina, hypertrophy of small articular process, degeneration of intervertebral disc can make the volume of vertebral canal decreased further. Old prolapse of lumbar intervertebral disc, malreduction of dislocation and fracture of lumbar vertebrae, postoperative spinal fusion or laminectomy may also cause lumbar canal stenosis. If there are traumatic inflammation and venostasis, they may make the symptoms worse.

Major points for diagnosis  
1. The disease occurs mostly in the middle-aged and older people.
 
2. Its special symptom is intermittent claudication, that is, the patient has pain, weakness and numbness of leg when walking. But after rest these symptoms will be relieved. The pain in the waist and leg is chronic and intermittent. Lumbago occurs in the lumbar and sacral portions, while leg pain is often in both sides or alternately in the left and the right sides. Cough can not aggravate symptoms and bicycle riding makes no trouble. In the case of a serious condition, there may occur urgency of urination and dysuria.
 
3. The limitation of backward extension of the waist with resultant leg pain is the characteristic sign of the disease. The other signs may be: The dermal sensory disturbance appears in the saddle region and the leg; dorsoextension of toe is weakened; Achilles’ tendon reflex disappears, and raising test of the straightened leg is positive. But sometimes no positive signs can be found at all.
 
4. X-ray film can show stenosis of lumbar intervertebral spaces, spur formation at posterior margin of vertebral arch, or spondylolisthesis, enlargement of lumbosacral angle, etc. Myelogram may reveal a typical defect of "Bee-waist-like", compression of sleeve root and segmental constricture. CT and MRI examinations can confirm the diagnosis.

Treatment  
Tendon-smoothing manipulation:    
The patient takes a prone position. The operator massages muscles of the waist and lower limb and painful points by pushing, rubbing, acupoint-pressing, rolling, kneading, lifting and pinching manipulations for 20 minutes. The manipulations should be gentle, and any drastic twirling and rotating manipulations should be avoided to prevent the aggravation of the disease. The manipulations are done once a day, with a course of ten times.

Herbal therapy  
Internal treatment based on syndrome differentiation
(1) Syndrome of insufficiency of the liver and kidney
 
Main symptoms and signs:
Dull lumbago possibly referring to lower limbs and aggravated after walking, with repeated attack; preference to pressure on waist, soreness and weakness of knee, muscular atrophy, pale tongue, and thready pulse.
   
Therapeutic methods:
Tonifying the liver and kidney, strengthening tendons and bones.

Recipe and herbs:
Modified Liuwei Dihuang Decoction. Specifically, Shudihuang (Radix Rehrnanniae Praeparata)15 g, Baishaoyao (Radix Paeoniae Alba)10 g, Huaishanyao (Rhizoma Dioscoreae )10 g, Fuling (Poriae)10 g, Danggui ( Radix Angelicae Sinensis )10 g, Shanzhuyu ( Fructus Corni Officinalis )12 g, Xuduan (Radix Dipsaci )10 g, Duzhong ( Cortex Eucommiaeulmoidis)10 g, Mudanpi ( Cortex Mountan Radicis)10 g, Zexie (Rhizome Alismatis )10 g and Zhigancao (Radix Glycyrrhizae Praeparata )5 g.

(2) Syndrome of blockage of stagnant blood
Main symptoms and signs:
Stabbing fixed pain in the waist referring to lower limbs, difficulty in walking, or ecchymoses on the tongue, stringy or choppy pulse.

Therapeutic methods:
Promoting blood flow to remove the stasis, regulating qi to alleviate pain.
 
Recipe and herbs:
Modified Taohong Siwu Decoction. The herbs see the treatment of syndrome of qi and blood stagnation in prolapse of lumbar intervertebral disc.
 
(3) Syndrome of blockage of pathogenic cold and dampness
Main symptoms and signs:
Cold pain in the waist and lower limb with heavy sensation and weakness, preference to warmth and intolerance of cold, difficulty in turning about, pale tongue with thin and greasy coating, moderate or slippery pulse.

Therapeutic methods:
Expelling cold and dampness, warming and dredging meridians.

Recipe and herbs:
Modified Magui Wenjing Decoction. Specifically, Mahuang ( Herba Ephedrae )6 g, Guizhi ( Ramulus Cinnamomi Cassiae )6 g, Qianghuo ( Rhizoma seu Radix Notopterggii)10 g, Duhuo ( Radix Angelicae Pubescentis )10 g, Xixin ( Herba Asari )3 g, Chishaoyao (Radix Paeniae Rubrae)10 g, Baizhi (Radix Angelicae Dahuricae ) 10 g, Cangzhu ( Rhizoma Atractylodis )10 g, Weilingxian ( Radix Clematidis )10 g and Gancao (Radix Glycyrrhizae )5 g.
 
External therapy:
Shangke Xiaoyan Paste or Tianhe Gutong Plaster is externally applied; or Zhenghonghua Oil or Zhenggu Liquor is topically applied.

Pelvic traction:       
After fixation with a pelvic hammock, traction is done with 10 to 15 kg for each leg, for 30 minutes, once a day, with a course of 7 to 10 days.

Hydro-acupuncture therapy:      
Extradural steroid injection therapy is commonly used, which has the action of relieving edema and adhesion of nerve root and alleviating symptoms. Generally, 10 to 20 ml of 1% procaine plus 10 mg dexamethasone is used for injection extradurally at the sick segment of spine, once a week, 3 times making up a course.