A. What is lumbar disc herniation?
To recognize lumbar disc herniation, first of all, we must know what is called intervertebral disc, the full length of the human spine is about 70 cm, which increases or decreases with stature. It consists of the cervical, thoracic, lumbar, sacral and caudal vertebrae. The part that connects each vertebra to each other in a disc-like structure is called an intervertebral disc. The main components of the intervertebral disc are collagen, proteoglycans and water, and are shaped like a pie. The “pie” is about 8-10 mm thick, with the cartilaginous surface of the vertebrae on the upper and lower sides; the central “filling” is the gelatinous nucleus pulposus, and the surrounding “crust” is a dense fibrous ring.
The human intervertebral disc due to age, strain and external forces, resulting in the rupture of the fibrous ring, the nucleus pulposus protrudes from the rupture or prolapse, compressing the lumbar nerve root or cauda equina, and a series of neurological symptoms such as lumbar pain and numbness, called lumbar disc herniation. The majority of what we usually call “sciatica” is actually caused by a herniated lumbar disc.
Second, what are the triggering factors of lumbar disc herniation?
1, lumbar load increase: sudden lumbar load increase, especially rapid bending, lateral bending or rotation, is the main cause of fibrous ring rupture.
2, lumbar trauma: when the violence is strong and does not cause fracture dislocation, it is possible to make the degenerated nucleus pulposus protrude.
3, improper posture: get up, stand up and other daily life and some work, if the lumbar in a flexed position, suddenly give an additional rotation action, it is easy to induce the nucleus pulposus protrusion.
4, increased abdominal pressure: abdominal pressure has a certain relationship with the protrusion of the intervertebral disc, and sometimes even in violent coughing, sneezing, constipation, forceful breath-holding can also occur herniation of the nucleus pulposus.
5, cold or moisture: can cause small blood vessel contraction, muscle spasm, so that the pressure of the push intervertebral disc increased, may also cause the degenerated push intervertebral disc rupture.
Third, how to determine suffering from lumbar disc herniation?
Lumbar disc herniation is common among young and strong people, especially among manual laborers or long-time sitting workers.
The most prominent manifestation is lumbar and leg pain, in which leg pain is heavier than lumbar pain, mostly sciatica or starting from the buttocks and gradually radiating to the lateral rear thigh, lateral calf, dorsal foot and lateral plantar and toe. The central type of prominence often causes bilateral sciatica. When the intra-abdominal pressure increases with coughing, sneezing, and urination and defecation, “electric shock”-like radiating pain in the lower extremities occurs, and even intermittent claudication may occur, and people may feel unbearable pain after walking for three to five minutes, and must bend their bodies sideways to slightly relieve the pain. In severe cases, it can also lead to a decline in sexual function and even paralysis, greatly affecting the quality of life.
Physical examination reveals that there can be pressure pain at about 1.5 cm next to the midline of the lower back, sometimes radiating to the lower limbs. In the posterior part of the lower extremity, there are also often pressure points on the pathway of the sciatic nerve. A normal person lying flat in bed can elevate the lower extremity to an angle of 90° or near 90° to the plane of the examination table without any pain, called a negative straight leg raise test. In most patients with lumbar disc herniation, lower extremity elevation is limited by lumbar and hip pain, and pain occurs, which is called a positive straight leg elevation test.
To confirm the diagnosis of a lumbar disc herniation and to determine the site and extent of the herniation, a lumbar spine CT, MRI (magnetic resonance imaging) or lumbar spinal canal imaging must be selected for further examination.
Lumbar disc herniation is classified according to morphology: type I: degeneration; type II: bulge; type III: protrusion; type IV: prolapse; type V: ossification.
Is lumbar disc herniation and lumbar spinal stenosis the same thing?
Lumbar spinal stenosis refers to any form of narrowing of the spinal canal, nerve root canal, intervertebral foramen, etc. caused by various factors of congenital development or acquired degeneration of the bony tissue or soft tissue constituting the spinal canal, causing compression or irritation of the cauda equina or nerve root and a series of clinical manifestations of the syndrome.
The clinical manifestations of lumbar spinal stenosis are
1, intermittent claudication: This is the most important feature of the symptomatic manifestation of spinal stenosis. Patients often have lumbar and leg pain when walking one or two hundred meters, and different sensations such as pain, numbness, heaviness, and weakness in the lower limbs that gradually increase, so that they have to change their posture or stop walking, and the symptoms can be reduced or disappear after squatting or resting for a few moments, and continue to stand or walk, and the symptoms reappear and are forced to rest again. Because of repeated walking and resting, the walking distance is gradually shortened. However, intermittent claudication may not occur when climbing mountains or riding bicycles.
2. Lower back pain: Most patients with lumbar spinal stenosis have a history of lower back pain or are accompanied by lower back pain. The pain is generally mild and is relieved or disappears when resting in bed, and the lumbar forward flexion is not restricted, but the posterior extension is often limited.
3. Nerve root compression symptoms and signs: Nerve root canal stenosis causes corresponding symptoms and signs of nerve root compression or irritation. Some patients show intermittent claudication, while others show persistent radiological nerve root symptoms, mostly soreness, numbness, swelling and pain, with different degrees of pain. The location of nerve root symptoms is related to the compressed nerve roots, which manifests as reduced pinprick sensation, abnormal pain sensation, reduced muscle strength and abnormal tendon reflexes in the corresponding nerve root distribution area.
4. Cauda equina compression: Lumbar spinal stenosis can lead to compression of the cauda equina nerve, symptoms and signs of the saddle area and symptoms of the sphincter muscle, and in severe cases, incomplete paralysis of the lower limbs and symptoms of urinary and faecal and sexual life disorders.
The major difference between lumbar spinal stenosis and lumbar disc herniation is that lumbar disc herniation generally does not have “intermittent claudication, inconsistency between complaints and objective examination, and limitation of lumbar back extension”. The flexion neck test and straight leg raise test are mostly positive in lumbar disc herniation, while the lumbar spinal stenosis is negative. In addition, lumbar spinal stenosis shows a less than normal sagittal diameter of the spinal canal on CT, MRI, and myelography, while lumbar disc herniation does not have this image. The two are separate diseases, but at the same time there is some connection, and the proportion of elderly patients with concomitant disease is quite high, which is the reason why people tend to confuse the two. This is because in the later stages of lumbar disc herniation, calcification of the prolapsed disc tissue occurs, and the corresponding small joints undergo synovial inflammatory exudative reactions, wear and tear of the articular cartilage, resulting in the development of hyperplastic bone at the lateral posterior border of the vertebral body and the articular eminence and secondary lumbar spinal stenosis. When the two diseases occur together, the patient may exhibit symptoms and signs of both, and clinical diagnosis is not difficult.
Diagnosis of lumbar spinal stenosis: According to the clinical manifestations, appropriate auxiliary examination methods are selected, such as X-ray plain film, myelography, CT scan, CT myelography, MRI, etc., in order to make accurate localization, qualitative and quantitative diagnosis.
V. What are the hazards of spinal stenosis?
Spinal stenosis can occur throughout the spinal canal of the human body, mostly in the cervical spine, lumbar spine, and less in the thoracic spine. The main hazards are.
1, pain: patients have obvious symptoms of neck, shoulder, lumbar and leg pain.
2. claudication: the symptoms are aggravated when the spine is posteriorly extended and reduced when it is forward flexed. A few patients have muscle atrophy of the lower limbs, and the Achilles tendon reflex is sometimes weakened or disappeared. And also accompanied by the appearance of limping symptoms.
3, limited movement: Movement disorders are mainly caused by the spinal stenosis vertebral body bundle sign, weakness of the limbs, stiffness and inflexibility, the first appearing weakness of the lower limbs, heavy legs, a “feeling of stepping on cotton”, unstable standing gait, unable to maintain balance, easy to suddenly kneel down, need assistance or crutches to walk, the symptoms gradually aggravated, the symptoms of the upper limbs appear later, but the pathological reflexes are present in the early stage. However, pathological reflexes exist in the early stage. The serious danger of spinal stenosis is the development of tetraplegia.
4. Nerve root irritation: symptoms of nerve root irritation, such as thoracic dorsal fasciculation and pain.
5. Urinary and fecal disorders: Urinary and fecal disorders usually appear late. In the early stage, it is inability to urinate and defecate, and it is more common to urinate frequently, urinary urgency and constipation. In the late stage, urinary retention and incontinence may appear.
Sixth, lumbar disc herniation and lumbar spinal stenosis treatment methods
1, conservative treatment: including bed rest, massage, drugs, traction, massage, acupuncture closed method, suitable for the first or less severe cases. The purpose of the therapy is to promote the retraction of the bulging part, improve local blood circulation, increase the vertebral space to reduce the compression and stimulation of the nerve root, eliminate the edema and inflammation caused by the compression of the nerve by the protrusion, and temporarily relieve the symptoms, but this therapy basically cannot completely eliminate and retract the protruding intervertebral disc. The lumbar circumference is fixed and the muscle exercise of the low back is strengthened, which can restore the protective effect of the lumbar muscles and surrounding ligaments on the lumbar spine and achieve the purpose of moisturizing treatment.
2.Traditional surgical treatment: Severe lumbar disc herniation with lumbar spinal stenosis must choose traditional surgical treatment methods.
3.Minimally invasive treatment: Compared with traditional surgical methods, minimally invasive surgical treatment techniques have the advantages of less trauma, faster recovery, no destruction of normal results in the spinal canal and no influence on the biomechanical stability of the spine. At present, our hospital has mature technologies such as minimally invasive posterior window decompression, minimally invasive posterior discoscopy, percutaneous radiofrequency ablation disc decompression and ozone minimally invasive interventional therapy.
There are various treatment methods for the treatment of lumbar disc herniation and lumbar spinal stenosis, each with its own advantages and disadvantages. An effective radical cure is minimally invasive surgery or open surgery to remove the herniated disc and enlarge the spinal canal. The type of treatment taken needs to be chosen by the specialist and the patient depending on the patient’s condition.