Lumbar disc herniation is a syndrome caused by degeneration of the intervertebral disc, rupture of the annulus fibrosus and protrusion of the nucleus pulposus, compression or irritation of the nerve roots and cauda equina. It is most common in lumbar 4/5, followed by lumbar 5 sacral 1, and lumbar 3-4. The first two account for about 90-96% of cases, and multiple intervertebral spaces at the same time account for only 5-22% of cases. Lumbar disc herniation is very common, and our hospital admits a lot of patients with lumbar disc disease every year, and in 2006, incomplete statistics of our hospital lumbar disc surgery reached 350 cases/year, and the excellent rate of surgical treatment is over 95%. The reason why people are still not very willing to accept surgical treatment is that a few patients with poor treatment results cause widespread concern in society during repeated treatment, while most of the cured patients always disappear silently from the sight of doctors and people for various reasons. (A) clinical manifestations and diagnosis and treatment: 1. medical history There is often a history of trauma, especially the history of bending and lifting heavy objects. It is more common in manual workers, and the incidence is higher in long-term bending workers and professional drivers. 2. Symptoms Low back pain: The vast majority of patients have low back pain, mainly in the lower back or lumbosacral region. Recurrent attacks are often accompanied by hip induction pain. The reason is mainly because when the lumbar disc herniates, it stimulates the outer fibrous ring and the sinus nerve fibers in the posterior longitudinal ligament. Sciatica: 95% of herniated discs occur in the lumbar 4-5 and lumbar 5-sacral 1 intervertebral spaces, so most patients with lumbar disc herniation have sciatica. It often occurs gradually, and the pain is radiating, from the buttocks, posterior and lateral thighs, and lateral calves to the heel or dorsum of the foot. The pain and numbness can be aggravated by coughing, sneezing, straining to defecate, and other actions that increase abdominal pressure; numbness of the limbs can be caused when the disc tissue compresses and stimulates the proprioceptive and tactile fibers. Muscle paralysis: When the lumbar disc tissue severely compresses the nerve roots, nerve paralysis and muscle paralysis can occur. The more common is the lumbar, when the nerve root is involved, the anterior tibial muscle, peroneal long and short muscles, the long and long extensor muscles with the toe long muscle paralysis weakness. Cauda equina syndrome: Central type lumbar disc herniation, often compressing the cauda equina nerve below the herniation plane, appears numbness in the perineum, defecation and urination weakness, may be manifested as acute urinary retention and defecation can not be controlled. 3.Signs There is pressure pain in the supraspinous ligament or paraspinous process of the herniated space. One side of the paravertebral muscle is spastic, and there is scoliosis of the spine, which is a postural compensatory deformity to relieve pain, and mobility is affected. When bending over, percussion of the paravertebral soft tissues in the protruding interval may elicit or aggravate sciatica, which is called positive paravertebral percussion pain. When lying prone, there is pressure pain along the course of the sciatic nerve. Straight leg elevation test (Lasegue test) and strengthening test: lying supine with knee straight, passively elevate the affected lower extremity until sciatica is present, which can be more than 60′-70′ when normal. In patients with lumbar disc herniation, when the affected limb is elevated 20-30 degrees, there is already sciatica, which is called a positive test. The first step of the strengthening test method is the same as before. After the sciatica appears, slightly lower the elevation angle of the affected limb until the pain decreases or just subsides, and then passively dorsiflex the ankle joint, and if sciatica appears, it is positive, indicating that the sciatic nerve is caused by the pulling. Sensory, motor and tendon reflex changes: when lumbar 1-3 disc herniation compresses the lumbar nerve root, skin numbness, weakness of knee extension and weakening or disappearance of knee reflex can be seen in the anterior medial calf; when lumbar 4-5 disc herniation compresses the lumbar nerve root, skin numbness, weakness of toe dorsiflexion and no change of tendon reflex can be seen in the lateral calf or dorsal foot; when lumbar 5 sacral 1 disc herniation compresses the sacral nerve root, skin numbness and plantar flexion of the calf and lateral foot can be seen. Skin numbness, weakness or inability of plantar flexion of toes, weakened or disappeared ankle reflex. 4.Auxiliary examination (1): The frontal and lateral images of the lumbar spine can show the disappearance of the physiological anterior convexity of the lumbar spine, scoliosis and narrowing of the intervertebral space, which indicate the degeneration of the intervertebral disc, but the x-image cannot confirm that there must be disc protrusion. It can also exclude some other bony lesions of the lumbar spine to facilitate differential diagnosis. It is the basic examination item for the diagnosis of lumbar disc herniation. (2): It has localization and qualitative significance for the diagnosis of lumbar disc herniation, but there are false positives. If used in combination with myelography (CTM), it is more valuable for diagnosis. (3): MRI can observe both transverse and longitudinal sections of the spinal canal and determine the degree and extent of compression of the spinal cord and nerve roots, which is valuable for diagnosis and treatment. The disadvantage is that it is expensive. Myelography: It can assist in diagnosis and currently uses a water-soluble contrast agent that has minimal effect on the patient, but still has the potential for pain and complications. Electromyography: electromyography can record the bioelectrical activity of the neuromuscles, which can be used to determine the functional state of the neuromuscles, and is helpful in the diagnosis and localization of cases with existing nerve root compression, but is not a routine test for lumbar disc herniation. (II) Differential diagnosis 1. Diseases with lumbar pain as the main cause Lumbar muscle strain and supraspinous and interspinous ligament injury: these are the most common causes of lumbar pain. 3rd lumbar transverse synovial syndrome. Vertebral isthmus crack with spondylolisthesis. Lumbar spine tuberculosis or tumor. 2. Diseases with sciatica as the main cause of low back pain Lumbar spinal stenosis: It refers to the narrowing of the spinal canal, nerve root canal and intervertebral foramen caused by various reasons, and the lesions that cause pressure on the spinal cord, cauda equina or spinal nerve root in the corresponding area. It is mainly characterized by intermittent claudication of neurogenic origin and often presents with heavy symptoms and light signs. However, the main differentiation also requires imaging findings. Nerve root or cauda equina tumors Diseases in which sciatica is predominant Pear-shaped muscle syndrome. Pelvic diseases, such as inflammation and tumor of the posterior pelvic wall. (C) Treatment 1. Non-surgical treatment accounts for about 80% of patients with the disease. Objective: to accelerate the decompression of inflammatory edema of the herniated part of the intervertebral disc and the irritated nerve roots, so as to reduce or release the compression of the nerve roots and reduce or subside the pain. Indications: First time attack, short duration of disease, mild symptoms and signs. Methods: Bed rest, traction, physiotherapy, massage, massage, etc. Percutaneous puncture chemical nucleolysis method: Percutaneous puncture injection of papain or collagenase to dissolve the nucleus pulposus tissue in the diseased disc, so as to reduce the pressure in the disc and achieve the treatment purpose. It is suitable for patients whose simple lumbar disc herniation is invalidated by conventional non-surgical treatment and is not accompanied by lumbar spinal stenosis, disc impaction and free type disc herniation. 2.Surgical treatment Purpose: To remove the herniated disc nucleus pulposus by surgical means. Indications: (1) long history, recurrent symptoms, non-surgical treatment is ineffective; (2) presence of cauda equina syndrome or single root nerve palsy; (3) lumbar disc herniation with lumbar spinal stenosis or slippage. Methods: Anterior and posterior surgery are available, and posterior surgery is more often used. The purpose of surgery: to remove the herniated nucleus pulposus and fibrous ring and to release the compression of the nerve root. The method can be performed by incision or through minimally invasive surgery such as discoscopy. I am often answering questions and answers from users of the hospital’s network, and the questions focus on two areas: 1. how to treat a herniated disc and how many treatment options are available. 2. how much does treatment cost in Guangzhou? I will answer the questions summarized as follows: treatment of lumbar disc herniation, about 70% can be cured by conservative methods. However, it cannot be eradicated and often recurs. The cost of each treatment varies according to the severity of the attack and is difficult to estimate. Minor herniation can be treated with minimally invasive surgery. Our hospital applies minimally invasive means such as laser melting disc, ozone and clamping, and the treatment process takes about 2-3 days, with small incisions and less pain, curing many patients, and the cost of surgery is about 5,000-8,000 yuan according to the current situation in Guangzhou. Whether or not to open the surgery directly, mainly according to the symptoms, if there is nerve function affected, such as numbness, weakness, incontinence and other conditions appear, it means that the nerve compression has been more serious, it is necessary to do the surgery to release the nerve compression, and in a timely manner, because it is difficult to recover from the degeneration and necrosis of the nerve compression. The cost of this surgery is about 10,000 RMB. If the nerve compression has been long and particularly severe, internal fixation of the vertebral arch nail should be considered, and the cost of surgery is about 30,000-40,000 yuan. In conclusion, the diseases of the lumbar spine are very complex, and there are many diseases whose performance is very similar to that of lumbar disc herniation, so it is necessary to consult a professional orthopedic surgeon for more comprehensive advice in case of lumbar pain. It is important not to rush to the doctor and misdiagnose the disease and delay the treatment.