What are the treatment misconceptions about lumbar disc herniation?

One of the misconceptions: back and leg pain is not considered a disease. According to statistics, more than 95% of people have experienced low back and leg pain in their lifetime. The diseases that cause low back and leg pain can involve almost all systems of the body. Some of the primary diseases of low back and leg pain disappear when they are cured, and some of them are not cured by themselves. Some patients therefore believe that low back pain is not a disease. In fact, low back and leg pain caused by lumbar disc herniation is not only considered a disease, but also must be taken seriously. Because this disease can not only cause back and leg pain, but also cause numbness, coldness, weakness of the lower limbs, and even bowel and urine disorders, which seriously affects the quality of life. Myth No. 2: Lumbar disc herniation is not curable. Lumbar disc herniation is characterized by easy recurrence, especially in those with neurological dysfunction, and a long repair process. Therefore, some patients and even some non-professional doctors think that lumbar disc herniation is not curable. In fact, the overall effect of lumbar disc herniation treatment is very good, with an excellent rate of about 95%. The so-called cure is not good for two reasons: one is the choice of improper method, the second is not adhere to the treatment. Some patients go to where they hear there is a new treatment, but they can’t stick to it anywhere, and end up running a lot of places with unsatisfactory results. Misconception No. 3: superstition in a particular method. There are two types of treatment for lumbar disc herniation, surgical and non-surgical. The latter has traction, massage, medication, plasma ablation, collagenase lysis, etc. It should be said that any one of these methods can cure some patients, but any one of them cannot cure all patients, and even in some cases, certain therapies are contraindicated. Therefore, the correct attitude is to choose the specific treatment method suitable for each patient according to clinical symptoms, signs, disease duration, and imaging examination, and not to exaggerate or superstitiously believe in a certain treatment, nor to subjectively resist a certain treatment. Myth No. 4: Misconceptions about surgery. Most patients with lumbar disc herniation can be relieved or cured by non-surgical treatment, but there are still some patients who need surgical treatment. There are two diametrically opposed misconceptions when it comes to the issue of surgery: one is blind surgery and the other is refusal of surgery. The former believes that only surgery can eradicate lumbar disc herniation, and thus does not choose to operate as long as it is a lumbar disc herniation and as long as the patient agrees. This adds to the unnecessary economic burden of the patient on the one hand, and increases the chance of “lumbar spine surgery failure syndrome” on the other. In fact, the indications for surgery for lumbar disc herniation are very strict, and surgery is not the first choice in the treatment of lumbar disc herniation. The latter amplifies the negative effects of surgery, such as nerve damage, and believes that surgery should not be done and will be paralyzing, thus conservative treatment. It should be said that some patients who are suitable for surgery can have their main symptoms relieved after conservative treatment, but there are always some symptoms left behind that are difficult to improve, while most patients with surgical indications cannot be replaced by any conservative therapy and must receive surgical treatment, and the earlier the better, otherwise, the loss of nerve function may become permanent, therefore, surgery and conservative issues should be treated discriminately, and neither surgery should be operated easily nor Therefore, the issue of surgery and conservatism should be treated discriminately, neither easily nor conservatively. Myth No. 5: Misconceptions about minimally invasive treatment of lumbar disc herniation. Discoscopy is designed for simple discectomy and is suitable for cases with single-segment disc herniation to one side and no spinal stenosis, especially for the free nucleus pulposus type. Compared with traditional open surgery, posterior discoscopic surgery has the advantages of less trauma, early bed mobility, and short postoperative recovery time, thus becoming more and more popular among orthopedic surgeons and gradually accepted by the majority of patients. With proficiency, experience, improved and increased instrumentation, clinical efficacy can be gradually improved. The best indications are single-segment herniation, herniation size not exceeding 50% of the spinal canal, or prolapse without significant displacement, and no previous surgical history. With the widespread use of this technique and improvements in instrumentation, the scope of use of this technique has expanded and most scholars believe that discoscopic techniques can be used for single-segment disc herniations of all degrees and types, with or without lateral saphenous fossa stenosis. However, the following conditions should be used with caution or should not be used: 1. central as well as very lateral herniations, which are difficult to operate due to surgical field of view limitations. 2. Older age and significant narrowing of the intervertebral space due to small joint hyperplasia. 3, Central type spinal stenosis or nerve root outlet stenosis. 4, The disc herniation has been completely calcified. However, we should see that the current posterior discoscope design has the following drawbacks: 1, the lens are single crystal lens design, the monitor image is a 30 ° angle field of view in front of the lens, is a flat map, rather than a three-dimensional image seen by the naked eye. 2, the endoscope lens length can not be adjusted, the operation of the vertebral plate gap bone, yellow ligament shows clear, tissue structure is easy to identify, revealing nerve roots, disc level when unclear, because of the increased distance of the vertebral canal sagittal diameter, the monitor image becomes smaller, the light becomes dark, tissue identification ability decreases. 3, the working channel is narrow, not suitable for more than 2 kinds of instruments put in; intra-vertebral plexus bleeding during surgery, not easy to stop bleeding; not easy to repair when the dura and nerve roots are injured; not easy to explore laterally, easy to miss the residual nucleus pulposus outside the field of view. 4, the end of the channel is not adapted to the fixation of the surface of the vertebral plate, prone to positioning errors and muscle crowding into the channel to obscure the lens. 5, surgical access although the use of the lamina safety drill can shorten the surgical windowing time, but the operation is still blind compared with incisional surgery, and occasionally the phenomenon of over-drilling bias occurs. 6, although many authors have designed various resectors to deal with disc fibrosis, bone redundancy, calcification, etc., the operation in the access has a greater risk compared with incisional surgery. Therefore, discoscopic surgery has its limitations. It is not a panacea. Small incision interlaminar openings for nucleus pulposus removal are still a very effective and less invasive method. Myth No. 6: Misconceptions about exercise. Many patients with lumbar disc herniation and even some non-specialist doctors believe that lumbar activity will aggravate the condition by further herniating the nucleus pulposus of the lumbar disc, and therefore limit lumbar movement. In fact, this is very incomplete. For patients with lumbar disc herniation, the strength of the muscles of the waist, back, buttocks and abdomen are weakened to varying degrees, and these muscles are essential for maintaining lumbar stability. If the lumbar movement is restricted, these muscles will undergo disuse atrophy and muscle strength will be further weakened, which is one of the important reasons for recurrent attacks in patients with lumbar disc herniation. Of course, lumbar exercise does not mean random movement, but must be carried out scientifically under the guidance of a physician.