There are many patients with chronic low back and leg pain in the clinic, and some of them are very worried that their disease will get worse and worse, and even eventually they will be paralyzed. What exactly is low back pain? Can it make people paralyzed? How should it be treated? Let’s analyze them one by one. 1.What can cause chronic low back pain? Chronic low back pain is very common in the clinic and refers to the symptoms of a group of diseases caused by various causes of chronic low back pain accompanied by radiating numbness and pain in the lower limbs. Among them, lumbar disc herniation, lumbar spinal stenosis and other causes are more common, in addition to congenital or acquired traumatic deformity of the lumbar spine and other causes. Various causes cause compression of the lumbar nerve roots, resulting in low back pain and even radiating pain and numbness in the lower extremities, and sciatica is the most common manifestation of compression of the lumbar nerve roots. Since the compression persists for a long time and will slowly intensify, the patient’s pain will worsen over time, and even manifestations of incomplete paralysis such as walking weakness or urinary and fecal dysfunction may occur. However, because the nerve is compressed for a long time and gradually adapts to the physiological environment of ischemia and hypoxia, complete paralysis of both lower limbs does not usually occur. Doctors are able to clarify the cause of lumbar pain through detailed physical examination combined with imaging examinations such as X-ray, CT or MRI. Although lumbar spine tuberculosis and tumors can also cause symptoms such as low back pain and radiating numbness and pain in the lower limbs, they are generally not classified as chronic low back pain because their treatment principles and prognosis are different from those of general low back pain. In addition, certain gynecological diseases and kidney diseases can also cause similar symptoms, and sometimes they may be confused with orthopedic diseases, so attention should be paid to differentiation. 2.How to choose the treatment method for chronic low back and leg pain? For chronic low back pain caused by different reasons, the treatment principles and treatment methods are different. For most of the chronic low back pain caused by lumbar disc herniation, non-surgical treatment has good effect and is the preferred treatment method for most patients; only a few patients who are not sure of the effect of long-term non-surgical treatment, or who have some effect but have recurrent symptoms, can consider surgical treatment; a few patients who have lower limb muscle paralysis and urinary and fecal dysfunction due to nerve root compression should be operated as early as possible; in addition, a few patients In addition, a small number of patients with acute onset of symptoms, severe pain, and serious impact on life may be considered for early surgery if non-surgical treatment is estimated to be ineffective. Lumbar spinal stenosis is generally caused by lumbar joint osteophytes, lumbar spine instability, lumbar spine slippage and other factors that lead to lumbar spinal stenosis due to aging and degeneration of the lumbar spine or strain injury, and the nerves are compressed and the patient develops symptoms of lumbar and leg pain. Most patients have difficulty in relieving symptoms effectively with non-surgical treatment and need to receive surgical treatment. 3.What non-surgical treatments are available for patients with low back pain? Non-surgical treatment is simple and convenient, with few complications, low cost and easy to accept by patients. It is the preferred treatment for most patients with lumbar disc herniation because of its satisfactory effect. Most patients can expect to be cured with the right combination of non-surgical treatments; even for patients who need to undergo surgery, various effective non-surgical treatments before and after surgery are essential. For patients with lumbar spinal stenosis who cannot tolerate surgical treatment for various reasons, non-operative therapies can be tried, but most patients have poor outcomes. The various non-surgical treatments currently used in clinical practice, including rest on a rigid bed, lumbar perimeter braking protection, oral or topical anti-inflammatory and pain-relieving, blood-stasis activating Chinese and Western drugs, lumbar back muscle exercises, local heat physiotherapy and other measures, can alleviate the inflammatory response of the protruding lumbar intervertebral disc or bone spur and other factors to the lumbar nerve roots after stimulation and compression, and to some extent alleviate the patient’s symptoms of lumbar pain and leg pain. Among them, resting on a hard bed is an essential basic element to ensure the effectiveness of non-surgical treatment, and it is best for the patient to rest absolutely in bed for a period of time. 4.How do patients with low back pain undergo surgery? For patients with lumbar disc herniation requiring surgery, the previous method was open surgery, cutting through the muscles and bone of the vertebral plate and finally removing the disc. Nowadays, minimally invasive surgery is used to remove the disc directly without damaging the muscles or the bone of the vertebral plate. Both methods can remove the herniated disc and relieve the pressure on the nerve root, effectively relieving the patient’s symptoms of back and leg pain. However, the latter is obviously more precise, has a faster postoperative recovery, and is more acceptable to patients. For patients with significant lumbar instability, the surgery requires removal of the herniated disc and enlargement of the narrow nerve root canal to relieve the compression of the lumbar nerve roots; at the same time, appropriate internal fixation combined with bone graft fusion is required to restore the stability of the spine, thus relieving the symptoms of lumbar pain caused by the instability stimulating the compression of the lumbar nerve roots. This type of surgery is relatively complex and requires a higher level of surgical technique and more bleeding, and some patients may even need to undergo surgical operations from the posterior and anterior sides of the lumbar spine sequentially or simultaneously. MRI is a routine examination item for lumbar spine patients, and many patients also need to review MRI after surgery to understand the decompression of lumbar nerve roots after surgery, which is also an essential examination means after the patient’s condition has recurred. 5.How effective is lumbar spine surgery and what are the risks? Although the operation of lumbar spine is relatively complicated and risky compared to other orthopedic surgeries, it has become a routine operation in large experienced hospitals with skilled surgical operation techniques and perfect surgical instruments. As long as the preoperative diagnosis is clear and the correct surgical approach is chosen, the majority of patients have satisfactory results and various complications rarely occur. Generally speaking, patients with shorter duration of disease, less complicated disease, younger age, and less severe nerve compression have better surgical results. In contrast, patients with urinary and faecal dysfunction and obvious muscle atrophy indicate that their nerve compression damage is more severe and the surgical outcome is relatively poor. 6.What are the precautions after lumbar spine surgery? After undergoing minimally invasive lumbar disc surgery, you can get out of bed the next day, while open surgery requires bed rest for 1 to 2 weeks. No matter which type of surgery is performed, you need to wear a lumbar brace for 3 months after getting out of bed to resume normal work life.