Lumbar disc herniation refers to the degeneration and protrusion of the human intervertebral disc tissues that causes clinical symptoms such as low back and leg pain. As a common disease causing low back and leg pain, there are clear industry standards for the clinical diagnosis of the disease, that is, the following four basic elements or conditions must be present at the same time to confirm the diagnosis: First, the patient is conscious of low back pain, leg pain or low back pain, the most typical symptom is radiating sciatica, early atypical cases or only low back pain, or lumbar and hip cramps, or lower limb “hanging tendons “The pain is characterized by a more comfortable sensation in the morning, and the pain is aggravated when coughing, sneezing, or even forceful stool or laughing, and very few patients only have a string of numbness in the lower extremities; secondly, there is deep localized pressure pain in the paravertebral space of the diseased vertebra, and typical cases can radiate to the distal end of the affected limb, and some patients with long duration of the disease or heavy symptoms still have restricted movement of the leg or lumbar spine back and forth, lumbar scoliosis, lower limb Third, CT or MRI examination indicates single or multi-segmental disc degeneration protrusion (expansion) and compression of the corresponding segmental dural sac or spinal nerve roots; fourth, lumbar spondylolisthesis, lumbar spinal stenosis, ankylosing spondylitis, osteoporosis, lumbar back strain (fasciitis), femoral head necrosis must be excluded. The fourth is that other primary diseases of lumbar pain such as lumbar spondylolisthesis, lumbar stenosis, ankylosing spondylitis, osteoporosis, lumbar back strain (fasciitis), femoral head necrosis, etc. must be excluded. It can be seen that the diagnosis of lumbar disc herniation is actually a complex systemic project, which is a decision made by the doctor after synthesizing the medical history, symptoms, physical signs and imaging examinations, and even after the treatment, etc. The trajectory of thinking includes affirmation – denial – re-affirmation, which is the negation of the negation. The trajectory of thinking includes affirmation – denial – re-affirmation, a conclusion of denial. If a diagnosis of “lumbar disc herniation” is made solely on the basis of the “disc herniation” findings suggested by CT or MRI films, it is wrong and one-sided, and the result will inevitably lead to mistreatment, including the possibility of wrongly receiving surgery. This lesson is profound. For clinicians, it is a sign of lack of knowledge and experience; for patients, the danger of being mistreated is even greater. Therefore, it is necessary to draw the attention of patients that they should first establish the most basic common sense to avoid being misled and mistreated! So why do the above misconceptions still exist today? In my opinion, the main reasons for the misconceptions lie in the following aspects. One, not aware of the objective existence of “asymptomatic lumbar disc herniation” “Asymptomatic lumbar disc herniation” refers to the protruding disc found on imaging (CT or MRI), but does not directly lead to the corresponding clinical symptoms such as back and leg pain. This phenomenon is relatively common in clinical practice, and domestic and international studies have found that asymptomatic lumbar disc herniation is as high as 30% to 50% in normal people. This indicates that herniated discs do not always cause typical low back and leg pain symptoms, and among the many painful root causes of low back and leg pain symptoms common in middle-aged and elderly people, herniated discs only account for about 1/5 of the total. So why does a herniated disc with nerve root compression on imaging such as CT or MRI not cause pain symptoms? We know from the research that normal nerve roots are protected by a connective tissue membrane, which has a certain elasticity and can produce a certain elastic avoidance effect on external pressure. Therefore, when the nerve root is pressurized, no pain can occur. Only when the nerve root is pressurized beyond its own elastic avoidance range and inflammatory edema of the nerve root occurs, will pain be caused. The physiological basis of asymptomatic lumbar disc herniation also lies in the mechanism of the reserve capacity of the spinal canal, i.e. the tolerability of the mechanical occupancy of the herniated disc tissue within the spinal canal and the compensatory effect of the body on the herniated disc tissue. Additional experiments have confirmed that mechanical compression does not directly produce radicular neuralgia, which is mainly due to secondary inflammatory edema. Asymptomatic lumbar disc herniation indicates no disease and requires no treatment, while whether the true cause of a patient with symptoms of low back pain is necessarily due to a herniated disc must be carefully considered and based on diagnostic procedures in contrast to the diagnostic criteria for lumbar disc herniation. The term “asymptomatic lumbar disc herniation” also includes patients with symptomatic lumbar disc herniation who have been cured by nonsurgical treatment. The ultimate goal of all non-surgical treatment is to try to make symptomatic “lumbar disc herniation” into asymptomatic “lumbar disc herniation”, and as long as this goal can be achieved, it is clinically considered “cured “, at this time the protruding disc tissue can be “in place” (the protruding nucleus pulposus tissue is still in place) quiet down, with our body in peace, its identity from a turbulent to cause harm to the human body “bad molecules The identity of the nucleus pulposus is naturally transformed from a turbulent and dangerous “bad element” to a “good person” who is at peace with himself. In this regard, we might call it a “silent disc” (silentdisc), the essence of which is “asymptomatic lumbar disc herniation”. All these facts show that the herniated nucleus pulposus is not completely pathogenic. Therefore, some scholars put forward the viewpoint of “harmlessness of herniated nucleus pulposus tissue”, that is, the herniated disc nucleus tissue in the human lumbar spine is harmless at some stage and to some extent as long as it does not cause clinical symptoms such as pain, or the pain disappears after treatment in symptomatic patients is also harmless, and in most cases it is not necessary to remove it surgically and then rest. The warning significance of the common phenomenon of asymptomatic lumbar disc herniation lies mainly in the fact that some cases with lumbar disc herniation confirmed by CT and MRI may not be the real cause of back and leg pain and may limit and mislead the clinical thinking of the treating physician, thus neglecting the detailed history taking and physical examination. In fact, such asymptomatic physiological degeneration is very common in the normal population, such as asymptomatic stones, asymptomatic bone spurs, asymptomatic cerebral infarction, asymptomatic hypertension, asymptomatic atherosclerosis, etc. Secondly, there is insufficient awareness of the diversity of the primary causes of low back pain. Early foreign studies have shown that there are more than 150 primary causes of low back pain, and lumbar disc herniation only accounts for about 20% of them. In addition, the causes of low back and leg pain in patients clinically may be relatively simple or multifactorial, especially in elderly people, most of whom have several primary causes of low back and leg pain, which may be a superposition of multiple pain etiologies. It is a common clinical misconception at present that as long as the patient complains of low back and leg pain, the patient is sent to CT or MRI examination without thinking, while detailed history questioning and careful physical examination are neglected, and the result will easily lead to simplification of clinical diagnostic procedures, or even be reversed. In fact, with the popularization of modern medical imaging and other auxiliary examinations, the basic clinical examination skills and clinical diagnostic thinking of clinicians have become more demanding. Experienced doctors should be able to determine the preliminary diagnosis or diagnostic direction after history taking and physical examination, and the results of the next auxiliary imaging examinations only confirm the clinical diagnosis and diagnostic direction, including the necessary exclusion diagnosis. As far as the clinical diagnosis of lumbar disc herniation is concerned, the objective existence of “asymptomatic lumbar disc herniation” and “diversity of lumbar pain primary causes” poses a strong challenge to the clinical diagnosis of lumbar pain primary causes. Imagine that if a clinician fails to follow the relevant diagnostic procedures for history taking and physical examination when seeing a patient, but simply associates the patient’s symptoms of low back pain with positive imaging changes, it will certainly lead to diagnostic errors. For example, inexperienced physicians are easily misled and disturbed by simple, asymptomatic lumbar disc herniation, or misdiagnose serious low back pain disorders such as tumors. In addition, when other low back pain primary diseases coexist with lumbar disc herniation, it is easier to be misled by the “herniated disc” on the imaging and neglect the rediagnosis of other combined diseases in the diagnosis and treatment, resulting in a missed diagnosis. Therefore, the protruding disc should not simply be directly correlated with the patient’s symptoms of low back pain, otherwise the clinical diagnosis of the disease is invariably simplified and the real cause of the disease may be overlooked, including the so-called malignant low back pain such as primary or secondary tumors of the lumbar spine. Therefore, in clinical practice, patients with lumbar leg pain should not be rashly diagnosed with lumbar disc herniation, nor should they be bound by auxiliary examinations, but should have a detailed physical examination and carefully pursue their medical history. Many patients upload their imaging films through this website in the hope that they can be diagnosed by doctors through the Internet. In fact, this practice is inappropriate, because the diagnosis of lumbar pain diseases such as lumbar disc herniation must be considered by a combination of factors, the most important of which is history taking and physical examination, so patients must go to the clinic in person. In addition, most patients in outpatient clinics only bring magnetic resonance imaging (MRI) or CT films, thinking that they are expensive and clear, so they must be good. In fact, what kind of imaging is based on the preliminary diagnosis, and the correct approach should be to do whatever the doctor suspects, with the aim of confirming his or her preliminary diagnosis and ruling out related diagnoses, rather than putting the cart before the horse and reading the report afterwards, otherwise it will be easy to be misled by the film. In this sense, the “film” is like a “liar”, and those who are easily “deceived” include not only doctors, but also patients, because the four diagnostic criteria mentioned at the beginning of the article include The four diagnostic criteria mentioned at the beginning of the chapter include “exclusion of diagnosis”. Therefore, for the clinical diagnosis of low back pain including lumbar disc herniation, the most common X-ray film should not be missing, even for the clearly diagnosed lumbar disc herniation. According to incomplete statistics, about 20-30% of patients with lumbar disc herniation have combined lumbar instability, scoliosis, shallow or absent anterior convexity, narrowing of the diseased intervertebral space, lumbar sacralization or sacral lumbarization, lumbar spondylolisthesis, arch fracture, bone spur formation or spondylolisthesis. They are either the direct cause of pain or indirectly involved in the formation of pain, and have a certain reference value for deducing the cause, judging the condition, and guiding treatment. Without X-rays, it is impossible to show a “holistic view” of the lumbar spine and to make the most objective and comprehensive judgment of the cause of pain, which may lead to misdiagnosis and underdiagnosis as a direct consequence. In this sense, although the most common X-ray does not directly show the protruding disc tissue, it is still indispensable for the diagnosis of lumbar pain such as lumbar disc herniation and cannot be ignored without it. Therefore, from a practical point of view, the recommended combination of imaging auxiliary examination for low back pain is X-ray plus CT, which can combine local and overall, and diagnose and exclude diagnosis. Of course, this combination is based on the suspicion of lumbar disc herniation and the need to exclude other primary causes of low back and leg pain. Because MRI is more useful for the soft tissues of the lumbar spine and has a large and innocuous scan, it is more useful for patients who are in doubt (e.g., suspected spinal tumors) or who cannot undergo CT (e.g., pregnant women). Incidentally, the clinical diagnosis of certain orthopedic diseases such as fractures, dislocations, and tumors is based primarily on imaging findings, even if the patient does not have any clinical symptoms such as pain, whereas the clinical diagnosis of certain degenerative diseases such as cervical spondylosis, osteoarthritis, lumbar spondylolisthesis, lumbar spinal stenosis, and lumbar disc herniation is based primarily on the patient’s presentation of The clinical diagnosis of degenerative diseases such as cervical spondylosis, osteoarthritis, lumbar spondylolisthesis, lumbar spinal stenosis and lumbar disc herniation is mainly based on the “characteristic” clinical symptoms presented by the patient, with reference to medical history, physical examination and imaging, especially not only on the basis of imaging results. Fourth, the herniated lumbar disc must be surgically removed or minimally invasive. Clinical practice shows that the majority of patients with lumbar disc herniation can obtain satisfactory recovery through active, regular, systematic and timely non-surgical treatment, and some of them are considered “cured” as long as their pain disappears and their function is restored according to the current industry standards of the State Ministry of Health and the Chinese Medicine Administration, and even various localities. “Cured”! All non-surgical treatments are basically effective without changing the space occupation in the spinal canal of the herniated disc tissue, i.e. “lumbar disc herniation can be treated without moving the nucleus pulposus”, that is, non-surgical methods treat “lumbar disc herniation” instead of “lumbar disc herniation”. In other words, the non-surgical method treats “lumbar disc herniation” rather than “lumbar disc herniation”, which is different from the Western medical idea of removing (eliminating) the herniated disc tissue through surgery or minimally invasive methods. So, what is the mechanism by which non-surgical treatment is effective? The research of several scholars illustrates that the “nucleus pulposus” doctrine of non-surgical treatment for lumbar disc herniation cure mechanism, that is, non-surgical treatment for lumbar disc herniation is not to reset the herniated nucleus pulposus, but to loosen the nerve root adhesions, smooth the local blood circulation, improve the local chemical environment of the lesion, and eliminate the sterile inflammatory reaction, etc. At present, most scholars believe that the protruding nucleus pulposus is only one aspect of the pathology of lumbar disc pain caused by lumbar disc herniation, but more importantly, it is the pathological process of local release of chemical substances containing glycoproteins and histamine, which stimulates the nerve roots and their surrounding tissues, resulting in a series of aseptic inflammatory reactions such as exudation, adhesions, tissue degeneration and local microcirculatory changes. In patients with lumbar disc herniation cured by various non-surgical therapies, the herniated disc can still be seen on imaging review, especially on recent review, because the standard is not whether the herniated disc is reset, returned or disappeared. Summary and insight (1) “Lumbar disc herniation” is never the same as “lumbar disc herniation”. The former is a natural physiological degeneration of the human intervertebral disc tissue (which can be simply interpreted as aging; the intervertebral disc is the largest non-vascular tissue in the human body and is the first of all human tissues to start aging and degenerating since the teenage years); the latter is an independent disease, but is related to the former. In short, a herniated lumbar disc with symptoms such as pain is a disease and requires medical treatment, while an asymptomatic herniated disc (e.g., occasionally detected by CT or MRI examination) does not require treatment; a symptomatic herniated disc disappears after active, regular, adequate and systematic non-surgical treatment, but the herniated disc tissue may (especially in the near future) continue to stay in place, for which It should not be regarded as “disease”. (2) Patients with lumbar pain should not only think of “lumbar disc herniation”, but should think more broadly and select the corresponding imaging examinations in accordance with the diagnostic and differential diagnostic procedures for lumbar pain under the guidance of a doctor, instead of simply doing CT or MRI examinations and ignoring the most common but most practical X-ray films. From another point of view, lumbar disc herniation patients after non-surgical treatment to heal the pain disappeared, even if the physiological state of the “good people”, you can assume the role of normal people in society, do not have to think about the protruding disc in the lumbar spine at all times, and do not see it as a “time bomb” buried in the body “and anxious. You can often meet such patients, especially those with large protrusions, although the pain symptoms disappear, but still worry about the protruding discs will “fall down”, and even worry about whether they will suddenly “paralyze” one day. (3) Patients with healed lumbar disc herniation, if lumbar and leg pain occurs again in the future, it is still necessary to make a correct diagnosis of lumbar and leg pain according to the diagnostic criteria and find out the source of pain, so that it cannot be simply regarded as lumbar disc herniation again, because it is possible that “this lumbar pain is not the other lumbar pain”. In other words, the next “recurrence” of lumbar and leg pain may not be the “fault” of the intervertebral disc. For example, if a patient who has previously had a lumbar disc herniation is cured and then sprains again after a period of time, only if the diagnostic criteria of “lumbar disc herniation” are not met can the diagnosis be made as “acute lumbar sprain”.