Diagnosis and treatment of lumbar disc herniation

Lumbar disc herniation (LDH) is a common condition that occurs mostly in middle-aged and elderly people. Lumbar disc herniation (LDH) refers to the degeneration, rupture and protrusion of the lumbar disc, which compresses and stimulates the nerve root or/and the cauda equina and produces lumbar and leg pains as the common clinical manifestations. With the increase of age, the degeneration of the annulus fibrosus and the nucleus pulposus is the basis of the pathogenesis of the disease, and the tearing of the annulus fibrosus caused by the traumas or repeated strain injuries is the direct cause of the pathogenesis of the disease. Clinical manifestations mainly include lumbar pain with radiating pain, coldness and numbness of the lower limbs, etc. Severe patients may suffer from urinary and bowel dysfunction and paralysis of the lower limbs. The treatment of this disease mainly includes conservative treatment, interventional therapy and surgery. Among the conservative treatments, traditional Chinese medicine (TCM) is unique and is the first choice for most first-time patients. It includes Chinese medicine fumigation or steam bath, lumbar traction, acupuncture, massage, internal Chinese medicine, sacral canal closure and other treatment methods. With the combination of hard bed rest, lumbar protection, lumbar and dorsal muscle functional exercise, and new analgesic concepts, 95% of patients with initial onset of disease can be cured. Interventional therapy is a minimally invasive therapy developed in recent decades, including nucleus pulposus dissolution, cutting and suction, radiofrequency ablation, intravertebral disc electrothermal therapy, ozone injection and so on. Currently, the indications and efficacy of the treatment are not completely accurate, and the overall good rate is not higher than that of conservative treatment. Surgery is recommended for patients with severe or multiple recurrences. Nucleus pulposus removal surgery is known as the “traditional classic” surgery in the industry because of its long history and exact efficacy. The main purpose of the surgery is to remove the protruding nucleus pulposus and other pressure-causing materials to relieve the pressure on the nerve roots and relieve clinical symptoms such as low back and leg pain. There are three specific types of surgery, including total laminectomy, hemilaminectomy, and “open-window” nucleus pulposus removal. With the advancement of medical science, open-window Nucleus Pulposus Removal is basically used nowadays, which has minimal effect on the stability of the spine. The near- and long-term efficacy is exact, and the postoperative recurrence rate is less than 7%. The use of microsurgical equipment such as headlamps and surgical magnifiers has made the surgery more and more delicate and tends to be “minimally invasive”. “Nucleus pulposus removal (NPR) is currently the most popular surgical procedure for lumbar disc herniation. Lumbar fusion may be considered for patients with combined or potential postoperative lumbar instability. Specific measures to prevent the recurrence of the disease include: ① lying on a hard bed, ② wearing a moderate waist cuff for protection, ③ strengthening the lumbar back muscle exercise, swimming, ④ taking oral medicine to consolidate the effect of liver and kidney tonic drugs, such as tonic bone pills, new body pain and blood stasis, etc, and ⑤ combining work and leisure, paying attention to labor protection.