1, acute lumbar sprain cause: acute lumbar sprain commonly known as “flash back”, mostly due to labor, work suffered huge external impact or improper posture, inadequate preparedness to carry too much weight so that the body can hardly withstand the role of external forces, the lumbar muscle fascia joint ligament rupture, edema, inflammatory contracture and other clinical symptoms leading to lumbar pain. Clinical manifestations: According to the different parts of the injury, the clinical symptoms are not exactly the same, generally there is lumbar pain and the pressure pain is the same as the pain point pointed out by the patient, the pain site is mainly in the lower back, there can be involved pain mostly in the buttocks, the back of the thigh, the root, hands on the waist, difficulty in action, aggravated by coughing and sneezing when standing or bending is more obvious, for a long time some patients appear lumbar scoliosis, convex to the healthy side. Diagnosis: Patients are mainly suffering from “dull pain” in the lumbar region, limited activity, negative reflexes, positive elevation test, no significant changes in X-ray examination, scoliosis is seen in the chronic phase, lumbar sprain should be differentiated from fractures, disc herniation, lumbar spondylolisthesis and tumor lesions, treatment is not difficult to rest, massage, physiotherapy, analgesia, local injections, exercise, etc. Analgesia, local injection, exercise and other related comprehensive therapy, chronic phase treatment must have appropriate and reasonable treatment plan to achieve satisfactory results. 2, lumbar disc herniation typing (1) according to the degree of protrusion classification: ① nucleus pulposus, fibers at the same time degeneration, atrophy, fibrous ring is not broken or normal, only mild expansion, known as bulging, ② fibrous ring part of the rupture, a part of the nucleus pulposus protrusion, known as protrusion, for the common clinical type; ③ fibrous ring completely broken, part of the nucleus pulposus from the posterior longitudinal ligament outward, embedded type, fixed type, free type, etc. It is called prolapse. (2) Classification according to the direction of protrusion: ① posterior paracentral type, ② central type, ③ intervertebral foramen type, ④ anterior type, ⑤ vertebral edge separation type, of which the posterior lateral curvature type is the most common, the central type and intervertebral foramen type is the second. (3) Several special types of lumbar intervertebral herniation: ① partially paralyzed sciatic nerve type; ② juvenile type disc herniation; ③ cauda equina integrated type disc herniation; ④ prolapsed lumbar disc herniation; ⑤ high lumbar disc herniation; ⑥ free herniated lumbar disc herniation. (4) disc herniation is distinguished from the following; ① lumbar intervertebral stenosis, ② cauda equina tumor, ③ vertebral slippage, ④ lumbar tuberculosis, ⑤ sacroiliac arthritis, ⑥ lumbar hyperplasia, ⑦ pear-shaped muscle injury syndrome; 3, lumbar disc herniation compression nerve symptoms division lumbar disc herniation is more likely to occur in the lumbar 3-4, lumbar 4-5 lumbar 5-sacral 1, these three discs are more weight-bearing, mobility is also large, the most likely to occur Herniation: lumbar disc herniation plane Radiation site Reflex change lumbar 1-3 gap lumbar, hip, lateral thigh pain numbness quadriceps muscle weakness, knee reflex weakness lumbar 3-4 gap sacroiliac, hip joint posterior lateral thigh front, calf anterior medial pain numbness knee reflex weakness disappears knee extension force weakness lumbar 4-5 gap sacroiliac, hip joint, thigh, calf posterior lateral pain, calf anterior lateral, dorsalis pedis The mother toe numbness Achilles tendon reflex is unchanged or weakened Lumbar 5-sacral 1 Sacroiliac, hip, thigh, posterior lateral foot pain, lateral calf foot including lateral toe numbness Mother foot stop and toe plantarflexion force is weakened, calf triceps muscle weakness, atrophy Achilles tendon reflex is weakened or disappeared. 4, lumbar disc herniation patients must need surgery? First of all, surgery is a kind of therapy, not a panacea, but it is more intuitive, so patients can carefully consider surgery, and surgery can also have a variety of problems, ① the effect is not yet sure, the medical community still disagree on the mechanism of surgery; ② easy to cause infection, the formation of post-operative fibrous scar tissue, so that the nerve root adhesions, causing “post-operative regenerative pain (3) surgery can cause neurovascular damage, (4) removal of the intervertebral disc after surgery is likely to cause lumbar instability and chronic low back pain, (5) but after surgery, conservative treatment will lose the time for treatment. In summary, patients must master the surgical features before treatment, in fact, the vast majority of intervertebral disc patients can be cured through non-surgical treatment, the real need for surgery only accounts for 5%, if a method of treatment is not good, do not lose confidence, choose another treatment method, after the regular system of conservative treatment, really invalid, seriously affect the daily work life, before considering surgery. Surgical indications for disc herniation: ① Acute attack with obvious cauda equina symptoms, i.e. the patient suddenly develops severe sciatica, sensory impairment, dysfunction of urination and defecation, requiring urgent surgical removal. ② Those with clear diagnosis and ineffective by regular systematic non-surgical therapy should receive surgical treatment to relieve pain. ③The symptoms recurrently occurring, after being cured by non-surgical treatment, the attacks occur within a short period of time and seriously affect life. ④Patients with herniated discs, combined with other causes of spinal stenosis, requiring spinal canal surgery for exploration. ⑤ Gradual development of the disease, aggravation of neurological symptoms, the emergence of muscle weakness, continuous numbness in the innervated area foot drop, physical examination of signs of nerve damage, combined with CT imaging and other examination of the nerve root compression status and symptoms, should be early surgery Lumbar spondylosis 5, lumbar spinal stenosis The lumbar spinal canal, nerve root canal and intervertebral foramen deformation or narrowing, causing the corresponding clinical symptoms is called lumbar spinal stenosis, according to the cause Depending on the cause, it is divided into primary and secondary, primary also known as congenital dysplasia and malformation or idiopathic lumbar spinal stenosis, secondary also known as acquired spinal stenosis, mostly due to disc herniation, osteophytes, and degenerative joint degeneration or spinal slippage traumatic fracture dislocation, osteitis, tumor, hematoma, etc., of which the most common is degenerative spinal stenosis. In the early stage, due to degeneration of the intervertebral disc, the nucleus pulposus becomes dehydrated and the expansion force decreases, causing relaxation of the ligamentum flavum and the joint capsule, resulting in spinal instability and pseudo-slip, causing stenosis of the spinal canal cavity. In the late stage, it can be followed by posterior expansion of the intervertebral fibular ring, posterior longitudinal ligament hypertrophy, ossification, posterior margin hyperplasia, joint capsule hypertrophy, joint hypertrophy, ligamentum flavum hypertrophy ossification, aseptic inflammatory edema, swelling resulting in a decrease in the volume of the canal cavity, the sagittal diameter of the normal lumbar spinal canal is more than 15 mm, and the transverse diameter is more than 20 mm, which can be divided into 3 types according to the causes: ① total spinal canal stenosis, ② lateral saphenous canal stenosis, and ③ nerve root canal stenosis. 3 kinds of nerve root stenosis. 6, lumbar spinal stenosis clinical bed and diagnosis ① long-term recurrent lumbar pain, soreness, sometimes can be radiated to the lower extremities, usually first lumbar pain, gradually appear leg pain, not affected by coughing, sneezing and other abdominal pressure, a small number of patients may have lower limbs numbness and cold, weakness, muscle atrophy, urinary and fecal disorders. Intermittent claudication is an idiopathic clinical symptom of spinal stenosis, mainly manifested as patients walking for hundreds of meters, appearing on one side or both, numbness, weakness, cramps, and gradually aggravated to claudication can not walk, squatting or sitting rest for a few minutes after the symptoms alleviate disappeared, and can continue to walk, the reason and walking upright, the pressure in the spinal canal increased, vascular compression, nerve ischemia, and cycling does not have this phenomenon. The main reason is that when cycling, the body leans forward, the space in the spinal canal increases, and the blood vessels are not under pressure. This is the so-called “car can travel a hundred miles, but it is difficult to take a hundred meters step”. Physical examination: lumbar hyperextension can cause lower limb numbness, a few do not have any positive signs, straight leg raising test is mostly normal, but combined with lumbar spine protrusion, the positive rate can be more than 80%, heel reflex can be weakened or disappeared, muscle strength is weakened, hypoesthesia, more complaints and fewer signs is also another feature of spinal stenosis. ④X-ray performance, thickening of the vertebral arch, narrowing of the vertebral plate gap, hypertrophy of the posterior joint, disorganized bone texture, hyperplasia of the posterior edge of the vertebral body, a few appearing slippage of the vertebral body, measurement of the sagittal diameter below 12 mm, CT performance of the vertebral canal sagittal warp less than 10 mm, can diagnose spinal stenosis, peri-vertebral bone spurs, ossification of the posterior longitudinal ligament, hypertrophy or ossification of the ligamentum flavum, hypertrophy of the articular eminence, extrusion and deformation of the dural sac. MRI examination is more accurate than CT, but the cost is higher if necessary. 7, lumbar spondylolisthesis ① etiology: lumbar spondylolisthesis is mainly due to bilateral isthmus disconnection, arch collapse, chronic misalignment between vertebrae, causing chronic back pain and leg pain symptoms, called lumbar spondylolisthesis, the disease occurs in middle-aged women, male to female ratio 1:5, with lumbar 4-5 spondylolisthesis is most common, the cause is mainly congenital isthmus developmental disorders, trauma, degeneration, so that the joint protrusion loss of function, can not prevent the vertebral body to move forward, there is a clinical difference between true and false spondylolisthesis. There is a clinical distinction between true and false slippage, one is the isthmus of the vertebral arch is not connected, so that the vertebral body forward or lateral displacement, known as true slippage, one is due to small joint degeneration, not damage to the vertebral arch slippage, known as pseudo-slippage. ②Clinical manifestations 2.1 Middle-aged women or above, lumbosacral, hip and lumbar pain, involvement pain with heavy numbness, generally able to engage in simple and light work, aggravated by standing, walking, lumbar position change, excessive exercise or weight bearing, and the symptoms are alleviated or disappear after a little rest. 2.2 Radiating pain and numbness in the lower limbs, which may occur bilaterally or unilaterally 2.3 Increased lumbar anterior convexity, posterior convexity of the hips, and folds in the lumbar iliac region in severe cases. 2.4 Restriction of lumbar spine movement and positive straight leg raise test when accompanied by disc herniation 2.5 On palpation, one spinous process on true slippage shifts forward, there is a step sensation in the posterior lumbar region, and pressure pain in the spinous process 2.6 In severe cases, there is numbness in the saddle area, incontinence, muscle weakness and paralysis in the lower limbs, and even incomplete paralysis occurs. ③Diagnosis X-ray plain film, orthopantomograph, slipped vertebral body height is reduced, tilt down, lower edge blurred, increased density lateral film: 80% of the upper and lower synapses can be seen between the crack line from the back to the front, the vertebral body anterior displacement. The degree of slippage is divided into 4 degrees; Ⅰ degree slippage not more than 1/4; Ⅱ degree, slippage between 1/4-2/4; Ⅲ degree: slippage between 2/4-3/4; Ⅳ degree, slippage greater than 3/4. CT examination: slipped vertebral arch with fissures, MRI: more diagnostic significance for combined fiber rupture and slippage. Lumbar spondylolisthesis 8, lumbar spinal stenosis The lumbar spinal canal, nerve root canal and intervertebral foramen deformation or narrowing, causing the corresponding clinical symptoms is called lumbar spinal stenosis, according to the different causes, it is divided into primary and secondary, primary also known as congenital dysplasia and malformation or idiopathic lumbar stenosis, secondary also known as acquired spinal stenosis, mostly due to disc herniation, osteophytes, and degenerative joint degeneration or spinal slippage traumatic fracture dislocation, osteitis, tumors, hematomas, etc., of which the most common is degenerative spinal stenosis. In early stages, degeneration of the intervertebral disc, dehydration of the nucleus pulposus, and reduced distensibility cause relaxation of the ligamentum flavum and joint capsule, leading to spinal instability and pseudoslip, causing stenosis of the spinal canal cavity. In the late stage, it can be followed by posterior expansion of the intervertebral fibular ring, posterior longitudinal ligament hypertrophy, ossification, posterior margin hyperplasia, joint capsule hypertrophy, joint hypertrophy, ligamentum flavum hypertrophy ossification, aseptic inflammatory edema, swelling resulting in a decrease in the volume of the canal cavity, the sagittal diameter of the normal lumbar spinal canal is more than 15 mm, and the transverse diameter is more than 20 mm, which can be divided into 3 types according to the causes: ① total spinal canal stenosis, ② lateral saphenous canal stenosis, and ③ nerve root canal stenosis. (3) nerve root stenosis. 9, lumbar spinal stenosis clinical bed and diagnosis ① long-term recurrent lumbar pain, soreness, sometimes can be radiated to the lower extremities, usually first lumbar pain, gradually appear leg pain, not affected by coughing, sneezing and other abdominal pressure, a small number of patients may have lower limbs numbness and cold, weakness, muscle atrophy, urinary and fecal disorders. Intermittent claudication is an idiopathic clinical symptom of spinal stenosis, mainly manifested as patients walking for hundreds of meters, appearing on one side or both, numbness, weakness, cramps, and gradually aggravated to claudication can not walk, squatting or sitting rest for a few minutes after the symptoms alleviate disappeared, and can continue to walk, the reason and walking upright, the pressure in the spinal canal increased, vascular compression, nerve ischemia, and cycling does not have this phenomenon. The main reason is that when cycling, the body leans forward, the space in the spinal canal increases, and the blood vessels are not under pressure. This is the so-called “car can travel a hundred miles, but it is difficult to take a hundred meters step”. Physical examination: lumbar hyperextension can cause lower limb numbness, a few do not have any positive signs, straight leg raising test is mostly normal, but combined with lumbar spine protrusion, the positive rate can be more than 80%, heel reflex can be weakened or disappeared, muscle strength is weakened, hypoesthesia, more complaints and fewer signs is also another feature of spinal stenosis. ④X-ray performance, thickening of the vertebral arch, narrowing of the vertebral plate gap, hypertrophy of the posterior joint, disorganized bone texture, hyperplasia of the posterior edge of the vertebral body, a few appearing slippage of the vertebral body, measurement of the sagittal diameter below 12 mm, CT performance of the vertebral canal sagittal warp less than 10 mm, can diagnose spinal stenosis, peri-vertebral bone spurs, ossification of the posterior longitudinal ligament, hypertrophy or ossification of the ligamentum flavum, hypertrophy of the articular eminence, extrusion and deformation of the dural sac. MRI examination is more accurate than CT, but the cost is higher if necessary. 10, lumbar spondylolisthesis ① etiology: lumbar spondylolisthesis is mainly due to bilateral isthmus discontinuity, arch collapse, chronic misalignment between vertebrae, causing chronic back pain and leg pain symptoms, called lumbar spondylolisthesis, the disease occurs in middle-aged women, male to female ratio 1:5, with lumbar 4-5 slippage is most common, the cause is mainly congenital isthmus developmental disorders, trauma, degeneration, so that the joint protrusion loss of function, can not prevent the vertebral body to move forward, the clinical is real pseudo-slip. There is a clinical distinction between true and false slippage, one is the isthmus of the vertebral arch is not connected, so that the vertebral body forward or lateral displacement, known as true slippage, one is due to small joint degeneration, not damage to the vertebral arch slippage, known as pseudo-slippage. ②Clinical manifestations 2.1 Middle-aged women or above, lumbosacral, hip and lumbar pain, involvement pain with heavy numbness, generally able to engage in simple and light work, aggravated by standing, walking, lumbar position change, excessive exercise or weight bearing, and the symptoms are alleviated or disappear after a little rest. 2.2 Radiating pain and numbness in the lower limbs, which may occur bilaterally or unilaterally 2.3 Increased lumbar anterior convexity, posterior convexity of the hips, and folds in the lumbar iliac region in severe cases. 2.4 Restriction of lumbar spine movement and positive straight leg raise test when accompanied by disc herniation 2.5 On palpation, one spinous process on true slippage shifts forward, there is a step sensation in the posterior lumbar region, and pressure pain in the spinous process 2.6 In severe cases, there is numbness in the saddle area, incontinence, muscle weakness and paralysis in the lower limbs, and even incomplete paralysis occurs. ③Diagnosis X-ray plain film, orthopantomograph, slipped vertebral body height is reduced, tilt down, lower edge blurred, increased density lateral film: 80% of the upper and lower synapses can be seen between the crack line from the back to the front, the vertebral body anterior displacement. The degree of slippage is divided into 4 degrees; Ⅰ degree slippage not more than 1/4; Ⅱ degree, slippage between 1/4-2/4; Ⅲ degree: slippage between 2/4-3/4; Ⅳ degree, slippage greater than 3/4. CT examination: slipped vertebral arch with fissure, MRI: more diagnostic significance for combined fiber rupture and slippage.