1. What is a lumbar intervertebral disc? Lumbar intervertebral disc is located between two vertebrae, is a structure with hydrodynamic properties, consists of nucleus pulposus, annulus fibrosus and cartilaginous plate, of which the nucleus pulposus is the central part, annulus fibrosus is the peripheral part, surrounding the nucleus pulposus, and the cartilaginous plate is the upper and lower part, which is directly connected with the vertebral bone tissues, the whole lumbar disc has a thickness of 8mm~10mm. the lumbar intervertebral disc is divided into the outer, middle, and inner layers of annulus fibrosus, the posterior part is the thinnest, but there are generally 1-2 layers of fibers. The posterior part of the annulus fibrosus is the thinnest, but generally there are 1-2 layers of fibers. The annulus fibrosus surrounds the nucleus pulposus and constitutes the peripheral part of the intervertebral disc, which is like a coiled spring, making the upper and lower vertebral bodies connected with each other and keeping the liquid content of the nucleus pulposus to maintain the position and shape of the nucleus pulposus. 2.What is lumbar disc herniation? When the lumbar intervertebral disc degeneration occurs, under the action of external forces, the annulus fibrosus ruptures and the nucleus pulposus protrudes to irritate or oppress the nerve root, resulting in lumbar pain accompanied by sciatic nerve radiating pain and other symptoms as the characteristics of a lesion. Most common in young adults, the ratio of men to women is 6:1, the most common site of lumbar 4 to 5, followed by lumbar 5 to sacral 1, this disease is the most common clinical spinal surgery. 3.How can patients determine whether there is lumbar disc herniation on their own? Clinically, there are many factors that cause low back pain, and lumbar disc herniation is only one of them, and many patients sometimes find it difficult to distinguish which cause of low back pain is actually present. As an independent disease, lumbar disc herniation has its certain specificity. Sometimes patients can find out whether they may suffer from lumbar disc herniation by paying a little attention, which is very helpful for going to the hospital in time for a clear diagnosis and symptomatic treatment. After experiencing sudden twisting and flashing of the waist, when symptoms such as lumbago, radiating pain and numbness of the lower limbs occur, patients should observe and check themselves from the following aspects to determine whether they are suffering from lumbar intervertebral disc herniation: (1) After an acute sprain, whether there is a limp, a hand holding the waist, or the affected limb is afraid of weight-bearing and presents a jumping gait, or the body likes to lean forward, and the hip is projected to the side of the posture. (2) Whether the lumbar spine is deviated to one side in an attempt to avoid pain, and whether the deviation relieves the pain to some extent. (3) Try coughing once or several times to see if the lumbar pain or lower extremity pain or numbness worsens. Or whether it causes low back pain when sneezing, urinating or defecating, and other actions that increase abdominal pressure. (4) When you are lying down, gently touch the middle and sides of the lumbar vertebrae in the back of the waist with your own hand or that of your family members to check whether there is any obvious pressure pain. (5) When resting in the prone position, if the pain still cannot be relieved, try to see if the pain symptoms are relieved when lying on the side, bending the waist, flexing the hips, or bending the knees. (6) In the supine position, then sit up and observe whether the lower limb on the affected side flexes the knee due to pain. (7) Lie in supine position, straighten the knee joint of the affected side, elevate the lower limb of the affected side, and observe whether the elevation is restricted due to pain. 4.What are the clinical manifestations of lumbar disc herniation? Typical symptoms of lumbar disc herniation are lumbar pain and radiating pain in the legs. However, there are some differences in clinical manifestations due to the location, size, diameter of the nucleus pulposus, pathologic characteristics, physical status and individual sensitivity. (1) Lumbar pain: more than 95% of patients with lumbar disc herniation have this symptom. The patient consciously lumbar persistent dull pain, lying down position to reduce, standing is aggravated, generally tolerable, lumbar can be moderate activities or slow walking, another for the sudden lumbar spasm-like pain, intolerable, need to lie down in bed, seriously affecting the life and work. (2) lower extremity radiating pain: 80% of patients with this disease, often in the lumbar pain to reduce or disappear after the appearance. The manifestation of radioactive stimulation or numbness from the waist to the thighs and the back of the calves, straight to the bottom of the foot. In severe cases, the pain can be electric shock-like pain from the waist to the foot, and is often accompanied by numbness. Those with mild pain can walk with a limp; those with severe pain need to rest in bed, preferring flexion, hip flexion and knee flexion. (3) Lower limb numbness, cold sensation and intermittent claudication: lower limb numbness is mostly accompanied by pain, and a few patients can show simple numbness, and a few patients are conscious of lower limb coldness and chilling. Mainly because the sympathetic nerve fibers in the spinal canal are stimulated. The mechanism and clinical manifestations of intermittent claudication are similar to those of lumbar spinal stenosis, mainly due to the fact that the pathological and physiological symptoms of secondary lumbar spinal stenosis can occur in the case of herniated nucleus pulposus. (4) Cauda equina symptoms: mainly seen in central type nucleus pulposus prolapse, which is less common clinically. Numbness and tingling in the perineum and dysfunction of urination and defecation may occur. Urinary incontinence may occur in women and impotence in men. In severe cases, there may be loss of bowel control and incomplete paralysis of both lower limbs. 5, lumbar disc herniation treatment principle lumbar disc herniation treatment ability principle: first conservative treatment after surgical treatment carefully, such as huge herniation or detachment lead to compression again, especially the appearance of cauda equina damage performance that is the sacrococcygeal numbness, urination and defecation and sexual function is affected very should be as early as possible to accept the surgery right away for the young people, such as the feeling of numbness is more serious and muscle strength decline is specially obvious, also need to be as early as possible surgical consent to release! Pressure 6, lumbar disc herniation treatment methods? The main problem of lumbar disc herniation is the compression of the nerve root by the herniated material and the consequent aseptic inflammation around the nerve root. The ideal approach is to relieve the compression and promote the inflammation to subside without increasing the patient’s pain. If the compression is not completely relieved, as long as the inflammation subsides, a basic cure can be obtained. There are many treatment methods in the clinic, but different patients should be treated with appropriate methods according to their different conditions. From the perspective of Western medicine, the treatment can be divided into two categories: non-surgical therapy and surgical therapy. Commonly used non-surgical therapies include: bed rest, medication, traction therapy, physical therapy, closure therapy, nucleus pulposus dissolution therapy and so on. Surgical treatment of lumbar disc herniation has become very mature after a long period of development, and is mainly divided into two types: anterior and posterior. Among them, posterior surgery is divided into total laminectomy, hemilaminectomy and window opening according to the different methods of entering the spinal canal. With the development of medical devices, some minimally invasive surgeries have been carried out in recent years to treat lumbar disc herniation and have achieved certain efficacy, such as percutaneous lumbar disc excision and suction, radiofrequency therapy, ozone therapy, discoscopic surgery and so on. A treatment method is not applicable to all patients with lumbar disc herniation, so spine surgeons should choose the most appropriate treatment method according to the specific pathological changes and symptoms of different patients. 7. Which patients with lumbar disc herniation are not suitable for surgery? Most of the patients with lumbar disc herniation can be cured after regular conservative treatment, generally only about 20% of the patients need surgical treatment, and the following cases are not suitable for surgical treatment. (1) The symptoms of lumbar disc herniation are mild and can be significantly improved after rest, but the impact on life and work is small and easy to cure. (2) Those who have the first attack of lumbar disc herniation, but the pain is not very intense and has not been treated conservatively. (3) Patients whose systemic or local conditions are not suitable for surgery, such as poor physical condition, or lumbar disc herniation combined with manifestations such as low back infection. (4) Patients who have not been clearly diagnosed, such as patients who are clinically suspected of lumbar disc herniation, but the symptoms are not very typical, and no disc herniation has been found by vertebral angiography or CT, MRI, etc., which can be observed and treated at the same time, and is not suitable for surgical treatment. (5) Patients with contraindications to anesthesia should not be treated surgically. However, the above situation is not absolute, should be based on the patient’s specific situation, under the guidance of the doctor, choose the appropriate treatment. 8.Which patients with lumbar disc herniation need surgery? Surgery for lumbar disc herniation is a more common and effective treatment for lumbar disc herniation. Surgery can completely eliminate the herniated material that oppresses the spinal nerves and other peripheral tissues, and fundamentally relieve the clinical symptoms of lumbar and leg pain. So which lumbar disc herniation should be treated with surgery? (1) The symptoms are serious, affecting the life and work, and the non-surgical treatment is ineffective; or the symptoms are serious and cannot be treated by non-surgical treatments such as traction, massage, and so on. (2) Those with extensive muscle paralysis, hypesthesia and cauda equina damage (such as hypesthesia in the saddle area and dysfunction of urinary and fecal functions, etc.), and those with complete or partial paraplegia. These patients are mostly central type herniation, or the fractured nucleus pulposus of the annulus fibrosus is detached into the spinal canal, forming a wide range of compression on the nerve root and cauda equina, and should be operated as soon as possible. (3) Patients with severe intermittent claudication, mostly with spinal stenosis at the same time, or X-ray and CT images show spinal stenosis, non-surgical treatments can not be effective, it is advisable to early surgical treatment. (4) For those who are combined with lumbar isthmus nonunion and spondylolisthesis, it is advisable to surgically remove the diseased nucleus pulposus tissue, and at the same time, perform bone graft fusion between the opposite side of the vertebral plate and spinous process. (5) For young and middle-aged patients with recurrent episodes, the indications for surgery can be appropriately relaxed in order to enable them to recover their labor ability as soon as possible. 9. Is there any risk of surgery for lumbar disc herniation? Surgery for lumbar disc herniation requires the surgeon to have a good grasp of local anatomical knowledge, strict aseptic operation techniques, gentle and delicate surgical skills, and the ability to deal with accidents on a contingency basis. In the surgical cases of lumbar disc herniation, a very small number of patients have more or less comorbidities due to the operation technique, which increases the pain of the patients, affects the effect of the surgery, and even the patients die due to the surgical complications. However, as long as the indications for surgery are strictly controlled, detailed examination is conducted, clear positioning is made, careful operation is carried out and postoperative precautions are observed, then surgical complications can be avoided and minimized as much as possible. In the past ten years since the establishment of the Department of Spine Surgery, thousands of cases of lumbar disc herniation surgery have been performed, with rich experience in surgical treatment, and so far there has not been any case of paralysis of the patient after surgery, and the treatment effect is good. It is recommended that patients choose the spine surgery specialist treatment, which can reduce the risk of surgery. 10.Can women of childbearing age still give birth after lumbar spine surgery? When women of childbearing age suffer from lumbar disc herniation and need surgery, some of them are worried about whether lumbar spine surgery will affect their fertility. From a more direct point of view, the location of the surgery has nothing to do with the female uterus, so it will not affect fertility after the surgery. However, during pregnancy, the weight of the gradually increasing abdominal volume and the lengthening of the force arm from the center of the intervertebral disc can increase the load on the lumbar region, which already constitutes a greater burden on a normal pregnant woman, and for women who are pregnant after lumbar spine surgery, the lumbar vertebrae themselves are already deficient to a certain extent, and coupled with the burden of pregnancy, the lumbar burden will be heavier, and may even result in severe lumbar pain, and some of them may stimulate the spinal nerves and other Some may stimulate the spinal nerves and other tissues to conduct to the lower limbs and cause pain in the lower limbs, but the pregnant woman will get better with rest and the symptoms will be eliminated after delivery. Therefore, women of childbearing age who have had lumbar spine surgery should pay attention to self-protection during pregnancy, such as ensuring rest and better attention to body posture, etc., and also pay special attention to lumbar protection after delivery to avoid recurrence of low back pain. 11.What is lumbar traction? Lumbar traction is an important measure in non-surgical treatment, which is to utilize the pulling force and counter-pulling force for the lumbar spine to achieve the purpose of treating lumbar disc herniation by pulling in the opposite direction. Lumbar traction can increase the lumbar intervertebral space, mainly lumbar 3, 4, 5, sacral 1 space. According to the research, lumbar intervertebral space widens 1.5~2.5mm after traction compared with before traction, the widening of the intervertebral space can make it become negative pressure, plus the tension of the posterior longitudinal ligament, which is favorable for the herniated nucleus pulposus partially to return to or change the relationship between the nucleus pulposus and the nerve root. The widening of the intervertebral space and the pulling apart of the articular synovial joints restore the normal shape of the intervertebral foramen, thus relieving the compression of the nerve root. Traction can also make the lumbar spine get sufficient rest, reduce the stimulation of movement, which is conducive to the absorption and subsidence of tissue congestion and edema, and can also relieve muscle spasm and reduce intervertebral pressure. Most of the early, mild lumbar disc herniation patients traction therapy is effective, but serious disc herniation, fibrous annulus rupture nucleus pulposus prolapse patients traction therapy effect is not good. 12.Which patients are not suitable for traction therapy? Traction therapy is a safe and rare method of treating all kinds of low back pain patients with serious complications. In addition to lumbar disc herniation, other acute and chronic low back pain, lumbar small joint disorders, etc. can also be treated with traction. However, traction is not suitable for the following patients. (1) Patients with unclear diagnosis and suspected destructive diseases of lumbar spine, such as tumor, tuberculosis or septic diseases, should not be treated with traction. (2) Patients with poor general condition, suffering from serious respiratory or circulatory system diseases or determined by the doctor to be unsuitable for traction therapy. (3) Patients with obvious osteoporosis are not suitable for traction therapy. (4) Patients who can be treated with traction after diagnosis, but the symptoms are aggravated and the pain is severe after traction. 13. What is the mechanism of physical therapy for lumbar disc herniation? The application of artificial or natural physical factors in the body to prevent and treat diseases is called physiotherapy, or physiotherapy for short. Physiotherapy is widely used in clinical practice, and it has important practical value in treating and preventing diseases and restoring functions, and often plays a role that other therapies cannot play. In the treatment of lumbar intervertebral disc herniation, it can also play an important auxiliary role. (1) Analgesic effect. Pain is one of the main symptoms of lumbar disc herniation, which is manifested as lumbar pain radiating to one or both lower limbs. All kinds of heat therapy and electric stimulation therapy in physical therapy can relieve pain and can play a symptomatic role. (2) Anti-inflammatory effect. In patients with lumbar disc herniation, due to rupture of the annulus fibrosus or compression of the nerve root by the herniated material, local inflammatory reaction often occurs. Heat therapy, short wave, ultra-short wave, infrared and other means of physical therapy have the effect of promoting the subsidence and absorption of inflammation. (3) The role of loosening adhesions and softening scarring. Physiotherapy can loosen adhesions caused by various reasons, especially for the recovery of patients with lumbar disc herniation who have received surgical treatment. (4) The role of excitation of nerves and muscles. The untimely treatment of lumbar intervertebral disc herniation can cause numbness of the lower limbs, muscle atrophy and other symptoms due to the nerve root compression for too long. Low and medium frequency electrotherapy can stimulate the excitation of nerves, so that the repair and regeneration, or electrical gymnastics to make muscle excitation contraction, but also to promote sensory recovery. 14, lumbar intervertebral disc herniation patients should pay attention to what problems of physical therapy? (1) Acute sprain-induced lumbar intervertebral disc herniation should be carried out 1 to 2 days after the injury and then physical therapy (except magnetic therapy). (2) Low- and medium-frequency electrotherapy is prohibited when there is eczema or septic disease in the skin of waist and legs. When there is localized skin sensory disorder, all kinds of heat therapy should be used with caution to avoid burns. (3) Lumbar intervertebral disc herniation patients in high fever or suffering from active tuberculosis should not be physiotherapy. (4) High frequency electrotherapy and magnetic therapy are prohibited for people with pacemakers. (5) Women should not use physical therapy during pregnancy and menstruation. If the patient’s symptoms worsen during physical therapy, the treatment can be suspended or consideration can be given to changing the physical factors to continue the treatment.