Lumbar disc herniation is a disease in which the nucleus pulposus protrudes and compresses the nerve roots after the rupture of the fibrous ring, causing mainly low back and leg pain. The lumbar intervertebral disc is equivalent to a micro-movement joint and is composed of a hyaline cartilage plate, a fibrous ring and the nucleus pulposus, which are distributed among the lumbar vertebrae. When the lumbar intervertebral disc ruptures due to degenerative changes or trauma, the nucleus pulposus prolapses from the rupture and compresses the lumbar spinal nerve, resulting in radiating pain in the back and legs. With herniated discs first of all, we should pay attention to changing the lifestyle, not suitable to wear shoes with heel, and can choose negative heel shoes if possible. In daily life, you should sleep on a hard bed, which can reduce the pressure on the intervertebral disc. Introduction “lumbar herniation” is the abbreviation for lumbar disc herniation. Lumbar disc herniation is a series of clinical symptoms and signs caused by degeneration of the lumbar disc, rupture of the fibrous ring and protrusion of the nucleus pulposus to stimulate or compress the nerve roots and cauda equina nerve, commonly known as “lumbar protrusion”, which is a common clinical disease and the main cause of lumbar pain. It often causes a lot of pain in life and work, and even disability and loss of working ability. Lumbar disc herniation is the main cause of low back pain and is one of the most common orthopedic clinical disorders, accounting for 10%-15% of patients with low back pain in orthopedic outpatient clinics and 25%-40% of inpatient cases for low back pain. Lumbar disc herniation is a common disease today and is difficult to rehabilitate, requiring a change in unreasonable lifestyle. Symptoms The most common symptom in patients with lumbar disc herniation is pain, which can be manifested as low back pain and sciatica. Typical sciatica is manifested as radiating pain from the buttocks, the back of the thigh, the lateral calf to the heel or the back of the foot. According to clinical statistics, about 95% of patients with lumbar synostosis have varying degrees of low back pain and 80% of patients have lower limb pain. In particular, lumbar pain is not only the most common symptom of lumbar disc herniation, but also one of the earliest symptoms. The pain occurs mainly due to the stimulation and compression of adjacent tissues (mainly sinus nerve and spinal nerve root) by the herniated and degenerated nucleus pulposus, as well as the overflow of biological substances such as glycoproteins in the nucleus pulposus, the release of histamine and other local chemical inflammation caused by chemical and mechanical radiculitis, resulting in mild or severe chronic low back pain. Moreover, degeneration of the lumbar spine also often occurs simultaneously in other tissues of the lumbar region, such as small intervertebral joints, ligaments, and lumbar muscles, causing local chronic inflammation of these tissues and causing pain. The two factors interact with each other and aggravate each other, causing progressive development of lumbar and leg pain. Complications Osteomalacia Patients with recurrent lumbar pain and prolonged lumbar pain with lumbar disc herniation will have a combination of joint degeneration and osteomalacia. On the one hand, the degeneration causes relaxation of the intervertebral disc and narrowing of the lumbar interval. On the other hand, osteophytes of the articular processes can lead to further narrowing of the intervertebral foramina, thereby increasing the pressure on the nerve roots. Lumbar spine osteophytes The osteophytes are mostly found at the edges of the degenerated discs. In the case of large bony bulges in the intervertebral foramen and in the posterior longitudinal ligament, the nerve roots may be compressed and the symptoms of lumbar disc herniation may occur. Lumbar spondylolisthesis The degeneration of a herniated lumbar disc can lead to lumbar instability and osteoarthritis of the articular processes. Both of these are major causes of lumbar spondylolisthesis. Lumbar instability The posterior joint of the disc in the three-joint complex of the lumbar spine degenerates and cannot maintain the stability of the spine, while both the vertebrae and joints become hyperplastic and eventually lead to fibrous or bony ankylosis. Therefore, it is a stage of degeneration when the lumbar spine is unstable. Lumbar spinal stenosis The narrowing of the intervertebral space caused by a lumbar disc herniation, the relaxation of the posterior protrusion of the fibrous ring, the hypertrophy of the ligamentum flavum, and the osteophytes of the posterior edge of the vertebral body and the intervertebral joints can cause the spinal canal to become smaller, which will make the original smaller spinal canal continue to narrow. Patients then suffer from long-term lumbar pain, lumbago, and consequently intermittent claudication. Disease classification The herniated nucleus pulposus in lumbar disc herniation stops in front of the posterior longitudinal ligament is called “herniation”, while the nucleus pulposus that crosses the posterior longitudinal ligament into the spinal canal is called “prolapse”. The nucleus pulposus is divided into 3 types according to the posterior protrusion site: 1. Posterior lateral protrusion type: the weakest posterior part of the fibrous ring is on both sides of the midline of the intervertebral disc, which is weak in itself and lacks the support of the strong central fibers of the posterior longitudinal ligament, so it is the most common site of lumbar disc protrusion. Clinically it is the most common, accounting for about 80%. 2. Central protrusion type: The nucleus pulposus protrudes through the posterior central part of the fibrous ring and reaches under the posterior longitudinal ligament. In addition to causing sciatic nerve symptoms, it can also stimulate or compress the cauda equina nerve, manifesting as perineal palsy and urinary and fecal disorders. 3, intravertebral foramen protrusion: refers to the nucleus pulposus posteriorly through the posterior fibrous ring and posterior longitudinal ligament into the spinal canal, into the intervertebral foramen, easy to miss the diagnosis, but fortunately its incidence is low, only about 1%. Etiology I. Degenerative changes: At present, it is believed that the basic cause is degenerative changes of the lumbar intervertebral disc. Degeneration is the objective law of birth, growth, decay and death of all living creatures, and because of the special physiological function of the lumbar spine, the degeneration of the lumbar intervertebral disc is earlier than other tissues and organs, and the progress is relatively faster. This process is a long-term, complex process. The so-called lumbar disc degenerative changes: that is, due to the compression of the disc by weight, coupled with the lumbar and often bending, back extension and other activities, easy to cause extrusion and wear of the disc, especially the lower lumbar intervertebral disc, thus producing degenerative changes. Degenerative changes in the lumbar intervertebral disc is the basis for the occurrence of this disease. Second, other factors: 1, the role of external forces: in daily life and work, some people tend to have long-term lumbar improper force, excessive force posture or incorrect body position, etc.. For example, long-term bending work of coal miners and construction workers need to often bend over to lift heavy objects. These long-term repeated external force caused by the injury of the intervertebral disc over time, aggravating the degree of degeneration. 2, the weakness of the disc’s own anatomical factors: (1) intervertebral disc in adults gradually lack of blood circulation, repair ability is also poor, especially after the degeneration, repair ability is even weaker. (2) The posterior lateral fibrous ring of the disc is weaker, while the posterior longitudinal ligament is significantly reduced in width at the lumbar 5 and sacral 1 planes, and the strengthening effect on the fibrous ring is significantly weakened. (3) congenital anomalies of lumbosacral segment: deformities of lumbosacral segment can increase the incidence, these anomalies cause unequal width of vertebral space and often cause joint protrusion and more rotational strain on the joint, so that the fibrous ring is subjected to different pressure and accelerates degeneration. 3, race, genetic factors: the incidence of people of color is lower, such as Indians and black Africans, the incidence is significantly lower than other ethnic groups. Clinical manifestations Low back pain Low back pain is the first symptom in most patients, with an incidence of about 91%. A small number of patients have only leg pain without low back pain, so it does not always occur in every patient. There are also some patients who have low back pain first and then leg pain after a period of time, while the low back pain reduces or disappears on its own and only complains of leg pain when they come to the clinic. The pain is mostly tingling, often accompanied by numbness and soreness in the legs and feet. Lower limb radiating pain Low back and leg pain is easy to attack after trauma, exertion and cold, each time for about 2 to 3 weeks, and can be gradually relieved. The pain is often relieved if you rest in bed during the attack. People who engage in heavy physical labor, especially those who repeatedly bend over, have a high chance of having low back pain. People who lack exercise and have poor muscle strength in the low back are prone to low back pain even if they occasionally bend over to lift heavy objects or sprain their back. Any factors that increase abdominal pressure, such as coughing, straining to defecate, laughing, sneezing, lifting heavy objects, chronic coughing, etc., are likely to trigger low back pain or aggravate the existing low back pain. Restricted lumbar activities The forward flexion and backward extension activities of the lumbar spine in patients with lumbar disc herniation are closely related to the degree of disc herniation. If the annulus fibrosus is not completely ruptured, the lumbar spine takes an anterior flexion position and posterior extension is limited. The reason for this is that when the lumbar spine is flexed forward, the ligamentum flavum between the vertebral plates is tensed, increasing the volume of the spinal canal and the posterior space of the intervertebral space, and the corresponding increase in tension of the posterior longitudinal ligament allows the herniated nucleus pulposus to be partially returned, thus reducing the symptoms of nerve root compression. Scoliosis This is a postural compensatory deformity adopted by patients with lumbar disc herniation to reduce pain. The lumbar spine is bent to the left or right and the spinous process can be distorted by touching the spinous process in the middle of the back, but this is not a unique sign of lumbar disc herniation, as about 50% of normal people also have a distorted spinous process. Intermittent claudication The claudication that occurs in lumbar disc herniation is mostly intermittent, i.e., pain and weakness in the lower extremities after walking a certain distance, and the symptoms can be relieved after bending down or squatting to rest and continue walking. With the passage of time, the symptoms gradually worsen slowly, and the shorter the standing time or walking distance before the appearance of the above symptoms, the more serious the condition. Sensory numbness Some patients with lumbar disc herniation do not experience pain in the lower extremities, but only numbness in the extremities, mostly due to compression of the proprioceptive and tactile fibers of the nerves by the disc tissue. The lateral thigh is a common area of numbness and can have a burning sensation when in contact with clothing and pants, and prolonged standing can aggravate the numbness. The cause of sensory disturbances in the lateral thigh is most often due to a bulging annulus fibrosus or joint degeneration and not due to a herniated disc.