Lumbar disc herniation is one of the more common disorders, mainly because the lumbar intervertebral disc parts (nucleus pulposus, fibrous ring and cartilage plate), especially the nucleus pulposus, have different degrees of degenerative changes, under the action of external factors, the fibrous ring of the disc ruptures, and the nucleus pulposus tissue protrudes (or prolapses) from the rupture in the posterior or vertebral canal, resulting in the adjacent spinal nerve roots suffer from irritation or compression, resulting in lumbar pain This results in a series of clinical symptoms, such as numbness and pain in one or both lower limbs. The incidence of lumbar disc herniation is highest in lumbar 4-5 and lumbar 5-sacral 1, accounting for about 95%. 1, etiology and pathogenesis degenerative disc degeneration: is the basic factor With age, the water content of the annulus fibrosus and nucleus pulposus gradually decreases, so that the tension of the nucleus pulposus decreases and the disc becomes thinner. At the same time, hyaluronic acid and keratinized sulfate decrease, low molecular weight glycoproteins increase, protofibrillar degeneration and collagen fiber deposition increase, the nucleus pulposus loses elasticity, the disc structure relaxes, and the cartilage plate becomes cystic. MRI confirms that degenerative disc degeneration can already occur in 15-year-old adolescents. A non-degenerated disc can withstand 6865 kPa (70 kgf/cm.) pressure, but a degenerated disc can rupture with only 294 kPa (3 kgf/crn.) pressure. Injury accumulation injury force: is the main cause of disc degeneration, but also the cause of disc herniation. Accumulated injury force, repeated bending and twisting movements are most likely to cause disc injury, so the disease is closely related to certain occupations and types of work. One-time violence (falling from a height or hitting the back with a heavy object) mostly causes vertebral fractures, or even crushed discs, but it is rare to see simple rupture of the annulus fibrosus and herniated nucleus pulposus. Genetic factors: the incidence of the disease is low in people of color; about 32% of adolescent patients younger than 20 years of age have a positive family history. Pregnancy: During pregnancy, the pelvic and lower back tissues are significantly congested, various structures are relatively relaxed, and the lumbosacral region is subjected to greater gravity than usual, which increases the chance of disc damage. 2, classification From the pathological changes and CT, MRI performance, combined with treatment methods can be made as follows: bulging type The fiber ring is partially ruptured, while the surface layer is still intact, at this time the nucleus pulposus is limited to bulge into the spinal canal due to pressure, but the surface is smooth. Most of this type can be relieved or cured by conservative treatment. Protruding type The fibrous ring is completely ruptured and the nucleus pulposus protrudes into the spinal canal, covered only by the posterior longitudinal ligament or a layer of fibrous membrane, and the surface is uneven or cauliflower-shaped, often requiring surgery. The ruptured and protruding disc tissue or fragmented pieces of the disc may be dislodged into the spinal canal or completely free. This type can cause not only nerve root symptoms but also cauda equina symptoms, and non-surgical treatment is often ineffective. Schmorl’s node The nucleus pulposus enters the cancellous bone of the vertebral body through the fissure of the cartilage of the upper and lower end plates, and generally there is only low back pain without nerve root symptoms, and surgery is not required. 3, clinical manifestations lumbar disc herniation is common in patients aged 20 to 50 years old, the ratio of men to women is about 4 to 6: 1. Within 20 years old accounts for about 6%, the incidence of the elderly is the lowest. Patients mostly have a history of bending labor or long-term sitting work, and the first onset is often during the process of semi-bending and holding weight or suddenly making twisting movements. According to the analysis of 1327 cases of lumbar disc herniation in China, the relevant symptoms, signs and occurrence rates are as follows. Symptoms: inflammation of nerve roots due to stimulation of chemical substances produced by ruptured disc tissues and autoimmune reaction; compression or straining of nerve roots with existing inflammation by the herniated nucleus pulposus, which obstructs venous return and further increases edema, resulting in increased sensitivity to pain; and ischemia of the compressed nerve roots. These three causes are interrelated and difficult to separate distinctly. Low back pain: It is the first symptom to appear in most patients with this disorder, with an incidence of about 91%. The pain is induced in the lower back due to irritation of the outer layer of the fibrous ring and the posterior longitudinal ligament by the protruding nucleus pulposus, via the sinus vertebral nerve, and sometimes affects the buttocks as well. Sciatica: Although high lumbar disc herniation (lumbar 2~3, 3~4) can cause femoral neuralgia, its incidence is less than 5%. The vast majority of patients are lumbar. The intervertebral space is herniated, so sciatica is the most common, with an incidence of about 97%. Typical sciatica is a radiating pain from the lower lumbar region to the buttocks, posterior thighs, and lateral calves up to the feet. About 60% of patients have increased pain due to increased abdominal pressure when sneezing or coughing. 4.Examination X-ray: X-ray alone does not directly reflect the presence of disc herniation. The scoliosis, vertebral body edge hyperplasia and narrowing of the vertebral space seen on the film are indicative of degenerative changes. If structural abnormalities are found in the lumbosacral spine (displaced vertebrae, collapsed vertebral roots, spinal slippage, etc.), this indicates that the adjacent discs will degenerate faster due to increased stress, increasing the chance of herniation. In addition, x-ray plain films can reveal the presence of bone diseases such as tuberculosis and tumors, which have important differential diagnostic significance. CT and MRI: CT can show the morphology of the bony spinal canal, the thickening of the ligamentum flavum and the size and direction of the herniated disc, which has a greater diagnostic value and is now commonly used. MRI can comprehensively observe whether each lumbar disc is diseased, and can also understand the degree and location of the herniated nucleus pulposus in the sagittal plane and identify whether there are other occupying lesions in the spinal canal. The disadvantage of the above two methods is that when there are different degrees of disc degeneration and herniation in multiple intervertebral spaces, it is difficult to confirm which lesion is causing the symptoms. B-mode ultrasonography: B-mode ultrasonography is a simple and non-invasive method for diagnosing disc herniation, which has developed rapidly in recent years. Due to the influence of the patient’s body size, the difficulty of localization and diagnosis as well as the level of the operator’s local anatomical knowledge and clinical experience, further research is needed to sum up the experience. Other electrophysiological examinations (electromyography, nerve conduction velocity and evoked potentials): can assist in determining the extent and degree of nerve damage and observing the effect of treatment. Laboratory tests are not very helpful for this disease, but they are valuable in differential diagnosis. 5.Treatment Non-surgical treatment of lumbar disc herniation can be relieved or cured by non-surgical treatment in most patients. The aim is to accelerate the decompression of inflammatory edema in the herniated part of the disc and the irritated nerve root, thus reducing or relieving the irritation or compression of the nerve root. The main indications for non-surgical treatment are: (1) young, first attack or short duration of the disease; (2) symptoms can be relieved on their own after rest; (3) no spinal stenosis on X-ray. Absolute bed rest: When the first attack of symptoms occurs, immediate bed rest is required. It should be noted that violent pushing and massage often do more harm than good. Corticosteroid epidural injection: Corticosteroid is a long-acting anti-inflammatory agent that can reduce inflammation and adhesions around the nerve root. Commonly used long-acting corticosteroid preparations plus 2% lidocaine epidural injection, every 7 to 10 days once, 3 times for a course of treatment. After an interval of 2-4 weeks, another course of treatment can be used, and if it is not effective, it is no longer necessary to use this method. If there is no basis, it is not advisable to add other drugs for co-injection to avoid adverse reactions. Chemical lysis of the nucleus pulposus: This method is to inject collagenase into the intervertebral disc or between the dura mater and the herniated nucleus pulposus, using this enzyme to selectively dissolve the nucleus pulposus and the fibrous ring without damaging the nerve roots, so that the pressure in the disc is reduced or the herniated nucleus pulposus is shrunk to achieve the purpose of relieving symptoms. Since this enzyme is a biological agent, it is worth paying attention to the possibility of allergic reaction, or local irritation and bleeding, or adhesions affecting the function of nerve roots again. Percutaneous nucleus pulposus is performed by entering the intervertebral space directly under X-ray surveillance through discoscopy or special instruments, and then aspirating part of the nucleus pulposus, thus reducing the pressure in the intervertebral disc to achieve symptom relief. It is mainly suitable for patients with bulging or mildly herniated nucleus pulposus, and not combined with lateral saphenous stenosis. The nucleus pulposus cannot be retracted in patients with significant protrusion or nucleus pulposus that has prolapsed from the spinal canal. Similar to the principle and indications of this method is laser pneumatization of the nucleus pulposus. Surgical treatment of patients with diagnosed lumbar disc herniation who have failed strict non-surgical treatment or who have cauda equina compression can be considered for myelotomy. Surgical treatment may result in complications such as disc infection, vascular or nerve root injury, and recurrence of postoperative adhesions, so surgical indications should be strictly controlled and surgical skills should be improved. In recent years, minimally invasive surgical techniques have been used to reduce surgical damage and achieve good results. 6, prevention Because the lumbar disc herniation is in the degenerative changes based on the accumulation of injury, and the accumulation of injury is an important factor in accelerating degeneration, so it is very important to reduce the accumulation of injury. Long-term sitting workers need to pay attention to the height of the table, chair, and regularly change the posture. Occupational work often bending laborers, should regularly stretch, chest activities, and use a wide belt. After treatment, the patient should wear a waist brace for a certain period of time, but should also strengthen the back muscle training to increase the intrinsic stability of the spine. Long-term use of lumbar girth without exercise of the lumbar back muscles may have adverse consequences due to disuse muscle atrophy. If you need to bend over to retrieve something, it is best to use hip flexion and knee flexion squatting to reduce the pressure on the posterior part of the disc.