A. General knowledge of herniated discs
1.What is an intervertebral disc? The full length of the adult spine is about 70 cm, which increases or decreases with the size of the body. It is the body’s “beam”, or “axis”, consisting of the cervical, thoracic, lumbar, sacral and coccygeal vertebrae. The disc-shaped structure between the vertebrae is called the intervertebral disc. The intervertebral discs connect the vertebrae and cushion gravity and external forces. The intervertebral discs are mainly composed of collagen, proteoglycans and water and are shaped like a pie. The “pie” is about 8-10 mm thick, the upper and lower sides are the cartilaginous surface of the vertebral body; the central “filling” is the gelatinous nucleus pulposus, surrounded by the “pie crust” is a dense fibrous ring.
2.What is lumbar disc herniation?
The human intervertebral disc due to age, strain and external forces, resulting in the rupture of the fibrous ring, the nucleus pulposus from the rupture protrude or prolapse, compression of the lumbar nerve root or cauda equina nerve, and a series of neurological symptoms such as lumbar pain, numbness, etc., called lumbar disc herniation.
It should be pointed out that the majority of common diseases like “sciatica” are actually caused by herniated lumbar discs.
3.What are the triggering factors?
①Sudden weight bearing or flashback: Sudden increase in lumbar load, especially rapid bending, lateral flexion or rotation, is the main cause of rupture of the fibrous ring.
② Trauma to the lumbar region: When the violence is strong and does not cause fracture dislocation, it may cause the degenerated nucleus pulposus to protrude.
(③Inappropriate posture: If the lumbar region is in a flexed position in daily life such as waking up and standing up, or in some work, and then an additional rotational movement is suddenly given, the nucleus pulposus may be triggered to protrude.
④Increased abdominal pressure: abdominal pressure has a certain relationship with the protrusion of the intervertebral disc, and sometimes the protrusion of the nucleus pulposus can occur even when coughing violently, sneezing, constipation, or holding the breath with force.
⑤ cold and damp: cold or damp can cause small blood vessel contraction, muscle spasm, so that the pressure of the pushing disc increases, may also cause the degenerated pushing disc rupture
4.How to determine suffering from lumbar disc herniation?
Lumbar disc herniation is common among young and strong people, especially among manual laborers or long-time sitting workers.
The most prominent manifestation is lumbar and leg pain, in which leg pain is heavier than lumbar pain, mostly sciatica or starting from the hip, gradually radiating to the lateral rear thigh, lateral calf, dorsal foot and lateral plantar and toe. The central type of prominence often causes bilateral sciatica. When coughing, sneezing, urinating or defecating, etc., intra-abdominal pressure increases, the radiating pain in the lower extremities is aggravated, and intermittent claudication may even occur, and the person feels painful after walking for three to five minutes, and must bend the body sideways to slightly relieve the pain. In severe cases, it can also lead to a decline in sexual function and even cause paralysis, which greatly affects the quality of a person’s life.
Physical examination can reveal that there can be pressure pain at about 1.5 cm next to the midline of the lower back, sometimes radiating to the lower limbs. There are also often pressure points in the posterior part of the lower limb, along the pathway of the sciatic nerve. A normal person lying flat in bed can elevate the lower extremity to an angle of 90° or near 90° to the plane of the examination table without any pain, called a negative straight leg raise test. In most patients with lumbar disc herniation, lower extremity elevation is limited by pain in the lower back and buttocks, which is called a positive straight leg elevation test.
The final diagnosis of lumbar disc herniation and determination of the site and degree of herniation requires lumbar spine CT or MRI (magnetic resonance imaging) examination.
5.How is lumbar disc herniation typed?
There are central type, lateral type and extreme lateral type according to the protrusion site. According to the degree of herniation, there are four types: bulging, herniated, prolapsed and free.
The American Academy of Orthopaedic Surgery recommends classification according to morphology: Type I: degeneration; Type II: bulging; Type III: protrusion; Type IV: prolapse; Type V: ossification.
6.What are the characteristics of various treatment methods?
Treatment methods
operation method time spent treatment effect conservative therapy medicine taking massage acupuncture massage 20 days a course stage relief symptoms, non-invasive closed therapy hormone anti-inflammatory, drug injection lesion location 3 times a course once a week temporary relief symptoms, minimally invasive lumbar nerve root canal injection method injection drugs, pelvic traction massage 3-4 months a course
Phase cure, minimally invasive percutaneous laser disc decompression puncture gasification disc hospitalization 3 days or no hospital eradication, minimally invasive (limited indications) percutaneous cut suction disc puncture cut suction hospitalization 6-7 days basic eradication, slightly more traumatic (limited indications) surgical treatment nucleus pulposus removal hospitalization half a month eradication, more traumatic (for heavier protrusion, prolapse, ossification)
Second, percutaneous puncture laser disc decompression (PLDD)
No need for incision, only one needle
In 1988, the United States was the first to report the success of percutaneous puncture laser disc decompression (PLDD). This method has a similar success rate to traditional interventional therapy, but is much less invasive.
Surgical Methods
Percutaneous laser disc decompression is performed under local anesthesia. A 0.5 mm diameter trocar needle is first punctured into the center of the disc, and then a 0.3 mm diameter laser lead is inserted into the needle, which is used to direct laser energy into the nucleus pulposus of the disc using optical fibers. The laser energy is designed under microcomputer control to automatically vaporize and “remove” the nucleus pulposus of the disc to reduce the pressure within the disc, thus eliminating the compression of the herniated disc on the spinal nerve and achieving the treatment purpose.
Advantages of PLDD
The procedure takes only about 30 minutes and the patient can walk on the floor after the procedure. The technique is safe, minimally invasive, no bleeding, no scarring, almost no complications, quick results (the effect can be observed during surgery), short hospital stay (usually three days) or no hospital stay, quick recovery, and low cost.
Postoperative treatment
After cervical disc herniation surgery.
The patient’s neck is fixed with an elastic neck collar, and the patient is escorted back to the ward in a wheelchair. Generally, the patient can go home after 4-6 hours of flat rest, and resume light work after another 5-7 days of bed rest. If the symptoms of radiculitis are more severe, intravenous drip of hepaticoside sodium 20mg + saline 250ml qd ,for 3-5 days, and salvia injection 250ml qd for 5-7 days.
Postoperative lumbar disc herniation.
Day 1: Discharged from hospital but with minimal activity, patients with pain should rest in bed, can go to the toilet and wear an elastic lumbar girth around the waist.
Day 2: After discharge, if there is no pain, you can walk, take a shower and wear an elastic waist brace.
Day 3: Simple housework can be done, but no lifting, and the lumbar girth can be released after sleep.
Day 4: The usual activities can be performed, and you can take a bath.
Day 5: You can resume work if you are working in a sitting position.
The lumbar girth is used only during the daytime for 15 days after surgery and can be completely lifted after 30 days.
This technology is an internationally advanced method of treating herniated discs and is known as “the revolution in the treatment of herniated discs”. Our department is the first neurosurgery specialty in China to carry out this program.
3.Surgical treatment of lumbar disc herniation: microscopic technology, minimally invasive treatment
For herniated discs that are not suitable for PLDD, we use microscopic neurosurgery techniques and minimally invasive methods such as high-speed grinding and drilling to remove the discs. The surgery enables complete decompression of the spinal nerve and minimizes harassment of the spinal nerve; we advocate lamina repositioning (i.e., after removing the disc, the cut lamina bone is repositioned and fixed), which maintains the stability of the spine and reduces the complications of postoperative scar adhesions and compression. It is effective, less invasive and safe.