Common treatment methods for lumbar disc herniation Lumbar disc herniation is one of the more common disorders, mainly because the lumbar disc parts (nucleus pulposus, annulus fibrosus and cartilage plate), especially the nucleus pulposus, have different degrees of degenerative changes, under the action of external factors, the annulus fibrosus of the disc ruptures, and the nucleus pulposus protrudes (or comes out) from the rupture site in the posterior or spinal canal, resulting in the adjacent spinal nerve roots suffering from The nucleus pulposus will protrude from the ruptured disc to the posterior side or the spinal canal, resulting in stimulation or compression of the adjacent spinal nerve roots, resulting in a series of clinical symptoms such as lumbar pain, numbness and pain in one or both lower limbs. The incidence of lumbar disc herniation is highest in lumbar 4-5 and lumbar 5-sacral 1, accounting for about 95%. The treatment of lumbar disc herniation is divided into non-surgical therapy and surgical therapy: 1. Non-surgical therapy Most patients with lumbar disc herniation can be relieved or cured by non-surgical treatment. The treatment principle is not to return the degenerated and herniated disc tissue to its original position, but to change the relative position of the disc tissue and the compressed nerve root or to partially retract it, so as to reduce the pressure on the nerve root, release the adhesion of the nerve root, eliminate the inflammation of the nerve root and thus relieve the symptoms. Non-surgical treatment is mainly suitable for: (1) young people, first time attack or short duration of the disease; (2) people with mild symptoms that can be relieved by themselves after rest; (3) people with no obvious spinal stenosis on imaging. (1) Absolute bed rest: In the first attack, bed rest should be strictly applied, emphasizing that neither bowel movements nor urination should be performed in bed or sitting up, so as to have better results. After 3 weeks of bed rest, you can get up and move under the protection of wearing a lumbar girth, and do not bend over and hold things for 3 months. This method is simple and effective, but more difficult to adhere to. After remission, the lumbar back muscle exercise should be strengthened to reduce the chances of recurrence. (2) Traction therapy using pelvic traction can increase the width of the intervertebral space, reduce the internal pressure of the intervertebral disc, retract the herniated part of the disc and reduce the irritation and compression of the nerve root, which needs to be carried out under the guidance of a professional doctor. (3) Acupuncture and tui-na and massage can relieve muscle spasm and reduce the pressure within the intervertebral disc, but note that violent tui-na and massage can lead to aggravation of the disease and should be done with caution. (4) Corticosteroid Epidural injection of corticosteroid is a long-acting anti-inflammatory agent that can reduce inflammation and adhesions around the nerve root. Generally, long-acting corticosteroid preparation + 2% lidocaine is used for epidural injection once a week, 3 times as a course of treatment, and another course can be used after 2-4 weeks. (5) Myelolysis method uses collagenase or papain, injected into the disc or between the dura and the herniated nucleus pulposus, to selectively dissolve the nucleus pulposus and the fibrous ring without damaging the nerve roots, in order to reduce the pressure in the disc or make the herniated nucleus pulposus smaller so as to relieve the symptoms. However, there is a risk of allergic reaction to this method. 2.Percutaneous myelotomy/myeloplasty The nucleus pulposus will be suctioned out or laser vaporized by entering the intervertebral space under X-ray surveillance with special instruments, so as to reduce the pressure in the intervertebral disc and achieve symptomatic relief. (1) Indications for surgery (1) history of more than three months, strict conservative treatment is ineffective or conservative treatment is effective, but frequent recurrence and heavy pain; (2) the first attack, but the pain is severe, especially in the lower extremities, the patient is difficult to move and sleep, in a forced position; (3) combined with the expression of cauda equina compression; (4) single nerve root paralysis, accompanied by muscle atrophy, muscle strength loss; (5) combined with spinal canal stenosis. (2) Surgical methods: partial laminectomy of the lamina and articular processes through a posterior lumbar back incision, or discectomy through the intervertebral space. For central disc herniation, after laminectomy, epidural or intradural discectomy is performed. In cases of combined lumbar instability and lumbar spinal stenosis, simultaneous spinal fusion is required.