1. Background and purpose
Degenerative lumbar spinal stenosis is a common musculoskeletal disorder that may significantly affects patient’s quality of life. It is believed that substantial number of visits at clinics/hospitals, including Korean medicine clinics/hospitals, are related to the treatments and symptom management, although there is no evidence-based clinical practice guideline of Korean medicine for this condition.
the purpose of the guideline is to inform Korean medicine doctors and patients about the current best available evidence of Korean medicine for the treatment of degenerative lumbar spinal stenosis.
2. Overview of disease
Degenerative LSS (M48.06 spinal stenosis, lumbar region / M48.07 spinsal stenosis, lumbosacral region) is a chronic spinal disease associated with compression of neural and vascular structures which is induced by degnerative changes in the spinal canal. LSS can be classified as central stenosis, foraminal stenosis, extraforaminal stenosis and subarticular stenosis based on the affected region.
the most representative symptom presentation of LSS is neurogenic claudication which involves either unilateral or bilateral lower extremities. Patients commonly experience symptom relief when rest or band forward the low back, but symptom worsening when they walk. Symptoms including pain, sensory discomfort and weakness of the affected legs are known to impact patients’ quality of life significantly. Pain on low back and buttock is less common, but can be presented while standing or walking.
In the perspective of Korean medicine, patients with degenerative LSS are classified as ‘Bi-syndrome’ and ‘Low back and leg pain’. Long-term exposure of depletion of Kidney qi energy, impaired Kidney due to heavy work or external evil of wind, cold, and dampness are believed to induce weakness of Kidney energy and stagnation of evil energy on the meridian which would result in stagnation of qi and blood, and incoordination of Young-Wi (營衛) Consequently, patiens will experience pain and numbness on the low back and legs.
