Many people have been diagnosed by doctors with herniated lumbar discs and have also been operated on as a result. After the hospital treatment, some are well, and even no longer appear. Some suffer for life, for which they go around for medical treatment, use a lot of methods, spend a lot of money or ineffective. The purpose of writing this article is to give people who are diagnosed with lumbar disc herniation or think they are a lumbar disc herniation a way to self-judge and choose a treatment method. Zhou Meng Han, Department of Orthopedics, The Fifth Affiliated Hospital of Xinjiang Medical University What is a lumbar disc Our spine is made up of many vertebrae strung together. Between each two vertebral bodies there is a disc made of fibrocartilage – the intervertebral disc – that connects them. The intervertebral disc between the lumbar vertebrae is the lumbar intervertebral disc (huh, a little bit of aluminum to play W guide to pull out a Mian receptacle shrimp scythe to replace the tooth of the tooth with the beauty of the shoulder. K怯蝗σ蝗ΦNa like the former tantalizing use of the Song punishments of the ホウ诽鬃槌傻摹V醒肼钥亢螅ú皇钦行模┦和桓鱿宋つ遥乓煌沤W guide to compose the nuclear W guide to compose the Phlegm Nao breakfast檬腔撼辶礁鲎倒侵涞某ΓΓㄖ亓ΓΓ renewed U strider怪校惺艹寤髯畲髯木褪茄虏康淖导蹋弟兄 The morphology of the spine and the occurrence of herniated discs is usually seen from the lateral appearance of the spine, which has a multiple curvature pattern. The cervical spine bends forward, the thoracic spine bends backward, the lumbar spine bends forward, the sacral spine bends backward, and the terminal caudal spine bends forward again. When we are in our mother’s womb, the spine is a whole arc, and the above-mentioned multiple curvature pattern is formed before we learn to stand. The anterior protrusion of the cervical vertebrae is formed by the progressive strength and pulling of the muscles at the back of the neck due to the weakness of the neck when being cradled vertically by the mother, the tilting of the head back and the tilting of the head when crawling. The backward curvature of the thoracic vertebrae is formed gradually by retaining the original curve and squeezing backward the bones that have not completely hardened due to the repeated expansion and expansion of lung breathing. The forward curvature of the lumbar spine is formed gradually by the downward pull of the abdominal organs during crawling and the gradually strong pull of the lumbar back muscles during sitting. The posterior convex arc of the sacrococcygeal vertebrae is similar to that of the thoracic vertebrae, and is a preservation of the original posterior convex arc. Thus by the time a person begins to learn to stand, the spine forms multiple anterior convex posterior curves. We have learned that the central portion of the intervertebral disc is slightly posterior to the intervertebral disc and the lumbar spine is bent forward. Since the vertebrae are almost all small diameter front and back, left and right diameter large flat cylinder, to arrange these columns into a forward bending arc, two vertebrae should be lined up between the front wide and narrow horn shape. So that the lumbar spine weight-bearing straight line is located in the rear half of the lumbar vertebral body. The pressure between the back half of the lumbar vertebrae is greater than the front half. This means that the height of the cartilage plate in the posterior part of the disc is shorter than that in the anterior part. If you want the lumbar vertebrae that have been fixed into a forward bend not to bend forward, the pressure between the vertebrae has to move forward (the flare that opens forward has to close into parallel or open backward), the pressure at the back of the vertebrae is less than the front, the central fibrous glue capsule moves backward under the pressure at the front, and the cartilage plate at the back of the disc has to be stretched (or increased in height). The tensile elasticity of the cartilage plate is weak, and repeated stretching occurs with fracture, and the central fibrous glue capsule and the partially fragmented cartilage plate around the capsule are extruded out of the disc along the fracture of the cartilage plate, which is the process of disc herniation. The lateral pattern of the disc is higher in the center (at the nucleus pulposus) than in the periphery. After the glue capsule of the lumbar disc breaks through the hold of the fibrocartilage plate, the core of the disc is empty, and when under pressure, the fibrocartilage plate near the core tilts toward the disc void after stress, and tends to separate and fragment from its peripheral fibrocartilage plate, which is the cause of recurrence after removal of a herniated disc. Three simple self-judgment of lumbar disc herniation First of all, it depends on the location of the pain, whether it is lumbar pain or leg pain. Lumbar pain alone is not a herniated disc. Leg pain alone also depends on the relationship between pain and physical activity. Pain with activity but no pain without activity is not a lumbar disc herniation. If you have pain all the time with or without activity, you may have a lumbar disc herniation. If there is not only back pain but also leg pain, it is not necessarily a lumbar disc herniation. It also depends on the relationship with physical activity. The identification method is the same as for leg pain only. Pain located below the back of the thigh is not necessarily a lumbar disc herniation. If the pain is located in the buttock and is accompanied by constant pain throughout the leg, and is not related to physical activity, consider it to be a lumbar disc herniation. Otherwise, it is not necessarily so. Walking a certain distance with pain and numbness in one or both legs may be a lumbar disc herniation. If you determine that there is a herniated disc, you should go to the hospital for further examination. To take an X-ray of the lumbar spine first. Then MRI of the lumbar spine will be done. The purpose of the X-ray is to exclude the interference of bone damage and to determine whether there is a vertebral bone variation. MRI is the best test to observe the intervertebral disc, and looking at the bone is not as good as X-rays, so it is not a substitute for X-rays. Both of these have their own uses for the diagnosis of lumbar disc herniation, and even having taken X-rays can rule out disc herniation without the need for an MRI. CT is essentially an X-ray tomography, which can look at the subtleties of the bone. It is not as good as X-rays to see the general body and not as clear as MRI to see the discs. So it is generally not used. It is only used for people who are not allowed to do MRI. If I say that a lumbar disc herniation does not cause any pain, you must think I am sick in the head. Oh. In fact, all the books that talk about lumbar disc herniation are wrong. It is true that a herniated disc does not cause any pain. Note that some of what I’m going to say below is something that is never in the textbooks (it’s my discovery). First of all, the lumbar disc is a structure left over from the embryonic development of the notochord, a degenerated and atrophied fibrocartilaginous tissue in which no nerves enter, and it is impossible to feel pain where there are no nerves. The actual “discogenic” pain is now very fashionable and is nonsense. Secondly, the lumbar pain when the lumbar disc is herniated, is excessive forward flexion of the spine, so that the back muscles are stretched and broken bleeding. It is not the result of a herniated lumbar disc. Because the pain is superficial in the back (can be touched), not in the deep. Third, a herniated lumbar disc will only produce radiating neuralgia in the corresponding segment when the herniated material touches the nerve roots. These touched nerve roots innervate the sensation and movement of the buttocks and legs, so the pain caused by a lumbar disc herniation is hip pain combined with leg pain rather than low back pain. Fourth, the pain after a nerve root is compressed by a lumbar disc herniation is a pain that is always present and will not disappear, although it may be reduced with changes in position. Therefore, the person whose pain disappears with the change of position is not a lumbar disc herniation. Fifth, pain caused by a herniated lumbar disc is caused by edema after the nerve root is touched. The nerve root can squeeze (push) away the contact of the herniated disc through edema, and after the edema disappears, the gap left after the edema disappears is left between the herniated disc and the nerve root, and the pain then disappears, but the herniation still exists. This also shows that a herniated disc does not cause any pain without touching the nerve root. V Treatment options for lumbar disc herniation Not all patients with lumbar disc herniation require surgery. As mentioned earlier, the pain caused by a herniated lumbar disc is produced by edema of the nerve root, and as soon as the edema disappears, the pain can disappear. The time between the edema of the nerve root and the decreasing of the edema is one week to three weeks. As long as you can get through this period, the pain will disappear naturally. Therefore, keeping the lower back inactive is the first choice for treating the disc. The way to keep the lumbar region inactive is to lie in bed, using the bed as a splint, lying flat on the bed, without the upper body gravity pressure on the lumbar disc, the pressure on the lumbar disc is minimized, the pressure on the protrusion disappears, and the nerve root does not continue to be squeezed. The nerve root also tends to push away the touch of the herniated disc on the nerve through the swelling force of edema. However, it does not push the disc herniation back into place, but only retains a small distance from the nerve root. Movement of the lumbar spine is likely to eliminate this distance, and this is the reason why lumbar disc herniation can recur. This is the principle of bed rest for lumbar disc herniation. What kind of lumbar disc herniation requires surgical removal? The first type is a person whose pain cannot be relieved by bed rest for more than three weeks in front. In this kind of people, the herniated disc squeezes the nerve root too tightly and the nerve root cannot be pushed away from touching by swelling, and only surgical removal can release the contact with the herniation. The second type is those who present with changes in sensation and movement of the lower extremities. For example, the leg is numb and insensitive to painful stimuli. The painful leg is not as strong as the painless leg, and the foot cannot be lifted when walking, etc. This indicates that the nerve has been compressed for a long time and damage has occurred, resulting in mild paralysis. Except for the two cases mentioned above, they can be treated without surgery. Six lumbar disc herniation surgical treatment divergence The classical method of lumbar disc herniation resection is to enter the spinal canal through the back to remove the herniated disc (only the part that should not enter the spinal canal is removed, not the whole disc). Nowadays, for financial gain, almost all hospitals attach a vertebral fusion to this procedure. The reason is that the lumbar vertebral body is unstable after disc removal and recurrence of lumbar disc herniation can occur. Is this really true? After lumbar disc herniation removal, some patients do need a second disc herniation removal surgery. That is because a herniated disc resection only removes the part of the disc that protrudes into the spinal canal, not the entire disc. It is possible that the disc core may remain if it is not completely necrotic and detached. During postoperative movement of the vertebral body, these remnants can be redirected backward into the spinal canal along the rupture of the disc. The nerve root is compressed. Most of the discs that can have residuals are young (meaning that the disc contains a lot of water, not that the patient is young. Usually the disc is not completely dehydrated as seen on the MRI image before the first surgery). Therefore, the reason for the second surgery is the choice of the timing of surgical removal of the herniated disc maturity and the thoroughness of the removal of the herniation. It is not vertebral instability. The lumbar vertebral body has ligaments in front and behind, and the articular eminence is fixed, so it is not unstable by and large. The small structural changes are injurious changes during activity. No fusion fixation is required. Just as few people have their entire ankle permanently immobilized because of an ankle sprain. Fusion of a vertebral body after removal of a herniated disc involves placing an artificial insert into the middle of the disc that can also prolapse into the spinal canal, creating compression of the nerve root. In order to avoid prolapse, the upper and lower vertebrae are fixed with metal brackets. Even after the vertebrae are fused, the fused vertebrae restrict the movement of the lumbar spine, making it difficult to move freely. If the implant is infected, it is even worse. None of these evils are possible with multiple classical lumbar discectomy surgeries even in the same area. Suffice it to say, this surgery is needed by doctors, it is needed by hospitals. It is needed by medical device vendors. The patient is the only one who does not need it. Seven lumbar disc herniation ineffective treatment Intervertebral disc excision and suction: is artificially caused by the lateral rupture of the intervertebral disc to reduce the pressure of backward protrusion, has a certain effect on the disc without protrusion, but is ineffective on the already protruded. Because the rupture of the disc’s fibrocartilage plate is unidirectional flap-like, the herniation is not possible to retract. Ozone ablation: It uses the corrosive nature of ozone to corrode the herniated disc. However, ozone does not have a head and does not think about who to erode, and when injected into the spinal canal it will erode all the tissues it encounters. Therefore it can burn the nerve roots and cause permanent damage. Physical therapy: This type of treatment is an attempt to treat the disease by local heating of the body and increasing local blood flow. However, the inflamed edematous tissues are themselves engorged with blood and therefore only aggravate the painful symptoms. Tui na massage: The essence of tui na massage is to ravage the injured tissues with the hands. People who perform this technique think they can heal injuries. But I wonder if you can answer the question: in the face of bleeding wounds, is it wrapped up and not moving to grow faster or massage massage on it to grow faster? The same injury, whether or not visible bleeding, the injured part of the blood edema, the treatment should be the same. So massage is not advisable. Acupuncture: This is the most complimentary treatment of the country. It is actually of no use. The cause of pain from a herniated disc is the nerve root being touched by the disc protruding in the spinal canal. Putting needles to the limb, adding unnecessary pain, does not have the slightest effect on the source of pain. It is like raising the soup to stop the boiling, scratching the itch. Plaster: This is also a national treasure. Its effect is the same as acupuncture. Instead, it increases skin damage. Fire cupping: this is another national treasure. Even if the body is full of copper-like bleeding spots, it will not change the nerve root touching the herniated disc. Hanging bar: through gravity pulling the torso, increasing the tension of the posterior longitudinal ligament, attempting to use this tension to bounce back the herniated disc protruding into the spinal canal. It seems to make sense. However, as seen in surgery, the posterior longitudinal ligament at the disc herniation is thin and mostly ruptured. It is impossible to form a forward tension (taut elasticity) force. In addition, when hanging, because the lumbar spine has an anterior convex curve, the anterior longitudinal ligament is subjected to the highest tension, and the posterior longitudinal ligament is relatively relaxed, so it is not effective. Bedside traction: This method is essentially tying the person to the bed. This method is really effective. However, its effect lies in bed inactivity, not traction. If you are tied to the bed, it is better to feel more comfortable lying in bed. There are countless folk remedies. In short, one result: they are not effective. The reason is that no matter how much tossing and turning is done, without surgery, the pain will not go away until the edema of the nerve root disappears. And the time for the edema to disappear is one to three weeks. In other words, by the time the pain is naturally gone. It is better to toss and turn like that as expected. Unless there is a hobby of giving money to others (free lunch is not much yo). Eight lumbar disc prevention According to the previously stated reasoning, lumbar disc herniation can be prevented. As long as you keep your lower back from bending forward as much as possible, you can prevent herniated discs. For example, many people pick up things on the ground or move objects in low positions with straight knees and bent backs. This can easily cause a lumbar disc herniation. The correct action is to squat straight down at the waist, even to pick up a piece of paper. The person who is prone to lumbar disc herniation can be a forceful person; it can also be a sedentary person. The person who exerts effort, as mentioned earlier (straight knees and bent back to bear weight). The reason why sedentary people are prone to herniated lumbar discs is also the forward bending of the lumbar spine. Long time leaning on the soft seat chair. The car driver’s chair is the best equipment to create a herniated disc. This seat is mostly reclined, lumbar vertebrae forward bending, coupled with the bumps of the car. More prone to lumbar disc herniation than just reclining. The best resting seat is sitting surface and backrest to form a vertical, while sitting surface and the ground to form an angle of about thirty to forty degrees. Such a chair, sit on the lumbar force is minimal, plus the lumbar cushion is better. General office seating should be higher than the head of the straight backrest hard surface is good, should not use soft cushions, lest the formation of damage. The lumbar disc herniation is not prevented by exercise, inappropriate exercise is more likely to create lumbar disc herniation, such as gymnastics, yoga, weight lifting, leg press, sit-ups and so on. In conclusion, lumbar disc herniation is a common structural injury to the lumbar disc. The reason for the pain in the lower extremity is that the herniated disc touches the nerve roots, causing nerve root damage. There are only two types of treatment. One is bed rest and waiting for the swelling of the nerve root to go down. The second is surgical excision. Surgical excision should be chosen from the classical method. Do not use the method of drawing a snake. Although there are now minimally invasive disc herniation resection surgeries, the difference between them and the classical surgery is the difference in incision, not the difference in method. The difference in incision for one disc is one centimeter (2.5 and 3.5). The difference between two intervertebral discs is the difference between one incision and two incisions. The total length of the incisions is not much different. You can choose as you wish.