1.What are the common causes of low back pain? Common causes of low back pain include trauma, chronic strain, osteoporosis, lumbar spine and intervertebral disc degeneration, infection, tuberculosis, tumor, developmental malformation, etc. For example: (1) degenerative diseases of the lumbar spine, such as lumbar spinal stenosis, lumbar disc herniation, etc. (2) Soft tissue injuries such as acute lumbar sprain, chronic lumbar strain pear-shaped muscle syndrome, etc. (3) Sacroiliac joint disorder, lumbar small joint disorder (lumbar small arthritis), occult spina bifida, lumbar spondylolisthesis and other bone and joint abnormalities. (4) Osteoporosis. (5) Seronegative spondylitis such as ankylosing spondylitis. (6) septic infection of the spine, etc. 2.How does intervertebral disc injury cause low back pain? Low back pain caused by intervertebral disc injury is called intervertebral discogenic low back pain. The outer layer of the intervertebral disc fiber ring is rich in nociceptive fibers and is sensitive to painful stimulation. The herniated disc causes mechanical compression of the nerve roots and also causes an immune inflammatory response causing pain, i.e. “disc autoimmunity”. Surgery confirms that the nerve roots near the herniated disc are often congested, edematous, and inflamed. Disc degeneration, genetic factors, acute trauma and chronic strain can all cause discogenic back pain. 3.What is the difference between a herniated disc and a bulging disc? A herniated disc is one in which the outer fibers of the disc are intact and not completely ruptured, and the herniated nucleus pulposus is blocked by the outer, thinner fibrous ring. Bulging discs are divided into two conditions: uniform (annular) bulging and limited bulging. Under normal circumstances, the disc is squeezed after upright activity due to gravity, the nucleus pulposus decreases in water, and the annulus fibrosus has a small uniform bulge in the form of an annular bulge with an intact annulus fibrosus that does not cause compression of the spinal cord or nerve roots. Displacement of the nucleus pulposus in a certain direction causes a limited bulge of the annulus fibrosus (restricted bulge), but the annulus fibrosus remains intact, compressing the spinal cord or nerve roots and producing clinical symptoms. The disc bulge is less severe than the disc herniation and the damage to the annulus fibrosus is less severe. 4. Is it correct to say that a bulging disc can be restored to normal? The lumbar intervertebral discs are subjected to strong stresses during spinal loading and motion and begin to degenerate continuously after the age of 20. In younger patients and with shorter duration of back pain, the pain and other symptoms disappear and the bulging disc may be repaired with reasonable treatment such as bed traction. But for degenerated discs, recovery is unlikely. 5.What are the symptoms of a herniated disc? Lumbar disc herniation was first proposed by Mixt and Bar in 1934. It is more frequent in people engaged in manual labor, with sudden onset of low back pain or gradual low back pain. The nature of low back pain can be sharp pain, soreness, dull pain, etc. The common ones are (1) low back pain. About 50% of patients have low back pain followed by leg pain, 33% of patients have low back pain and leg pain at the same time, and 17% of patients have leg pain followed by low back pain. (2) Sciatica. The pain is mostly radiating nerve root pain, and the sites are lumbosacral, posterior hip, posterior lateral thigh, lateral calf to heel or back of foot. In a few cases, the pain may radiate from the bottom to the top. (3) Lower abdominal pain or anterolateral thigh pain. This pain is mostly referred pain and is seen in high-grade disc herniation. (4) Numbness. (5) Intermittent claudication. Pain is heavy in the standing position but light in the sitting position, unable to walk long distances, requiring a break to continue walking, but no significant pain when riding a bicycle. (6) Cauda equina syndrome. Central type lumbar disc herniation with alternating left and right sciatica and numbness in the perineal area, and weakness or uncontrollable defecation and urination. Later the pain disappears and there is incomplete paralysis of both lower limbs, sphincter dysfunction, functional impotence in men and urinary retention and pseudo-incontinence in women. (7) Muscle paralysis. Nerve paralysis muscle paralysis when the nerve is severely compressed. Foot drop and inability to extend the thumb dorsally are most common. In individual women, acute protrusion of intervertebral disc tissue due to a sudden increase in abdominal pressure during delivery can cause severe compression of nerve roots. This is manifested as sudden onset of calf paralysis after delivery with little pain. It is called maternal birth palsy to distinguish it from neonatal birth palsy. (8) Coldness of the affected limb. The skin temperature of the lower legs and toes decreases, with the toes being obvious. 6.How is a herniated disc treated? The treatment methods for lumbar disc herniation include two categories: conservative treatment and surgical treatment. There is also a method between conservative and surgical treatment methods, such as percutaneous puncture disc shaving, laser treatment of herniated discs and chemical dissolution of the nucleus pulposus. However, each method has certain indications, and only by choosing the correct method for different conditions can we obtain good results, otherwise it will be counterproductive and even cause serious consequences. Conservative treatment methods include bed rest, traction, physical therapy and massage, etc. 7.What is intervertebral disc degeneration? Degenerative disc degeneration includes degeneration of the fibrous ring, degeneration of the cartilage end plate and degeneration of the nucleus pulposus. degeneration of the intervertebral disc begins to occur after the age of 20, and gradually increases with age. Degeneration of the fibrous ring is mainly manifested by tearing of the fibrous ring, forming one or more radial fissures; the nucleus pulposus contains about 88% water, and degeneration is mainly manifested by dehydration, decreased elasticity and expansion, and after middle age, tears and fissures can often be found in the cartilage end plate. After the degeneration of the intervertebral disc is prone to disc protrusion or prolapse, compression of the nerve root causes pain, numbness, weakness and other symptoms. 8.What is lumbar instability? Lumbar instability is a mechanical concept. Lumbar instability refers to the pathological changes that occur when the lumbar vertebrae cannot maintain their normal position in relation to each other under normal load, and the resulting series of clinical manifestations. It usually refers to degenerative lumbar instability, i.e. degeneration of the spine, which makes the degenerated segment very weak and hard and cannot be loaded normally, and clinical symptoms mainly manifested by lower back pain appear. 9.What is spinal stenosis? Spinal stenosis is one of the common diseases that cause low back pain or low back pain. Any narrowing of the bony or fibrous structures of the lumbar spinal canal, nerve root canal or intervertebral foramen that causes symptoms of compression of the cauda equina or nerve roots is called lumbar spinal stenosis. Primary (congenital) lumbar spinal stenosis is mainly caused by growth dysplasia. Secondary spinal stenosis is caused by acquired factors, including hypertrophy and laxity of the ligamentum flavum, disc herniation, vertebral dislocation, osteophytes at the superior articular eminence and posterior edge of the vertebral body. Medical causes of spinal stenosis include lumbar nucleus pulposus removal followed by autogenous bone grafting and compression fracture followed by spinal fusion. These patients gradually develop low back and leg pain with cauda equina intermittent claudication after bone graft fusion. Stenosis due to degeneration includes: osteophytes at the posterior superior border of the vertebral body, articular proliferation, degenerative disc degeneration and degeneration of the vertebral body causing degenerative slippage of the vertebral body, disc degeneration with bulging fibrous ring, hypertrophy of the ligamentum flavum, ossification of the posterior longitudinal ligament,. The lateral saphenous fossa of the triangular shape is shallow and less likely to stenosis. The trilobar shaped lateral saphenous fossa is deep and stenosis occurs more frequently. Therefore, all lateral saphenous stenosis occurs in the trilobar lumbar spinal canal of the inferior lumbar spine 4-5. 10.When does a patient with spondylolisthesis need surgical treatment? If the diagnosis of spondylolisthesis is clear, the symptoms are severe or recurrent, affecting daily life and work, after conservative treatment is ineffective, and the patient has no obvious contraindications to surgery. For nerve root cauda equina and other important tissues have obvious compression without surgical decompression may have serious consequences. Surgery can be considered after comprehensive consideration of the patient’s specific situation. Especially patients with malignant disease should strive for early detection and early surgery if conditions allow. 11.What is laminectomy? The purpose of laminectomy is to explore the spinal canal, remove the hyperplastic bone, prolapsed discs, calcified ligaments and displaced fracture fragments in the spinal canal, etc. The ultimate goal is to release the material in the spinal canal that is compressing the nerve roots and restore the patency of the spinal canal. Depending on the needs of the condition, total laminectomy, hemi-laminectomy, and windowing on the lamina can be done.