1. What are the causes of lumbar disc herniation? Lumbar disc herniation refers to the lumbar disc degeneration, rupture, protrusion, compression and irritation of the nerve root or / and the cauda equina nerve and produce back and leg pain as the common clinical manifestations of the disease. With age, the degeneration of the annulus fibrosus and nucleus pulposus is the basis for the development of the disease, and the tearing of the annulus fibrosus caused by trauma or repeated strain injury is the direct factor for the development of the disease. 2.What are the symptoms of lumbar disc herniation? (1) Lumbago with radiating pain in unilateral lower limbs: manifested as calf pain, “short tendons”, aggravated by bending, coughing, straining to defecate and exertion. Bed rest, especially the use of flexion of the hip and knee position when lying in bed, lumbar and leg pain relief. (2) Lower limb numbness: with the prolongation of the disease, the lower limbs begin to appear numbness. In the early stage, it is allergic to pain, which is manifested as “hot” burning pain in the calf and the back of the foot or the sole of the foot. Later on, it gradually turns into numbness, and the patient feels that the skin is thickened and the sensation is slow. Finally, the sensory function of the calf and foot is gradually lost. (3) Coldness of the lower limbs: some patients feel that their lower legs are cold and “cold wind”. This is the result of peripheral vasoconstriction caused by stimulation of the sympathetic nerves in the nerve roots. (4) Dysfunction of urination and dullness of sensation in the saddle area: this is the manifestation of compression of the cauda equina nerve in patients with central lumbar disc herniation. Urinary dysfunction is manifested as frequent urination, urinary urgency, waiting for urination, dribbling of urine or urinary incontinence. Defecation dysfunction is manifested as constipation, weakness of defecation, etc. 3.What are the treatment methods for lumbar disc herniation? It mainly includes conservative treatment, intervention therapy and surgery. Conservative treatment is the first choice for the majority of patients with initial onset of the disease. It includes traditional Chinese medicine fumigation or steam bath, lumbar traction, acupuncture, massage, medication, sacral closure and other treatment methods. Systematic conservative treatment, together with hard bed rest, lumbar immobilization and lumbar dorsal muscle functional exercise, 95% of the patients are satisfied with the treatment results. Surgery is recommended for patients with severe or multiple recurrences. Interventional therapy is a minimally invasive technique developed in recent decades, including nucleus pulposus dissolution, cutting and suction, radiofrequency ablation, intravertebral disc electrothermal therapy and ozone injection. At present, the indications and efficacy of treatment are still uncertain, and the overall good rate is not higher than that of conservative treatment. 4.What is the principle of TCM holistic treatment for lumbar disc herniation? According to TCM, deficiency of the liver and kidney is the basis of the disease, and wind-cold or labor injury or external injury is the trigger. The stagnation of blood and qi in the lumbar region or the invasion of wind, cold and dampness into the lumbar collaterals, the blood stasis stimulates the meridians and induces lumbar and leg pain. If only a single therapy is chosen, it is difficult to take into account all the pathological processes. Either it treats the symptoms but not the root cause, or the effect is slow. Combination of diseases and symptoms, and treatment of both symptoms and root causes is the basic idea of TCM treatment, and comprehensive treatment is the key to ensure the achievement of therapeutic effects. Therefore, only for the disease’s pathological basis, pathological products, pathological results and clinical manifestations, the use of symptomatic, on the disease, on the body’s overall integrated treatment program, in order to receive twice the result with half the effort. 5, lumbar disc herniation in what circumstances need surgical treatment? When one of the following conditions exists, surgery should be considered to avoid irreversible paralysis caused by the nerve root or cauda equina being compressed for too long. (1) Patients who have had the first attack and have been ineffective after 6 weeks of systematic conservative treatment; (2) Patients who have had two or more recurrences; (3) Patients who have a large herniated disc with obvious compression of the nerve root and the dural sac, and obvious neurological dysfunction such as numbness of the lower limbs and muscular atrophy; [Indications for Emergency Surgery] Urinary and fecal incontinence, saddle numbness, or paralysis of the lower limb muscles and the protrusion is huge as confirmed by imaging, such as CT or MRI, and the protrusion is huge. The dural sac and nerve root are severely compressed. 6.What are the surgical methods for lumbar disc herniation? (1) Nucleus pulposus removal surgery Nucleus pulposus removal surgery is known as the “traditional classic” surgery in the industry because of its long history and precise efficacy. The main purpose of the surgery is to remove the protruding nucleus pulposus and other pressure-causing materials to relieve the compression of the nerve root and alleviate the symptoms of low back and leg pain. There are three specific types of surgery, including total laminectomy, hemilaminectomy and open nucleus pulposus removal. With the advancement of medical science, the “open-window type” is basically used nowadays. This type of surgery has minimal damage to the stability of the spinal column, and the near- and long-term efficacy of the surgery is accurate, with a recurrence rate of less than 7% after the surgery. The use of minimally invasive instruments such as headlamps and surgical magnifiers makes the operation more and more delicate and tends to be “minimally invasive”. It is the most respected technique in domestic and overseas orthopedic circles. (2) Lumbar spine fusion can be considered for patients who have combined or may have lumbar instability after surgery. 7.How is the efficacy of lumbar disc herniation surgery? The efficacy of lumbar disc herniation surgery is precise, and the lumbar and leg pain disappears rapidly or relieves significantly after the surgery. Symptoms of nerve damage such as numbness, muscle atrophy, and weakness of the affected limbs will also improve significantly with the improvement of nerve nutrition. Since the 1980s, our department has surgically treated more than a thousand patients with lumbar disc herniation group. In recent years, drawing on minimally invasive concepts and instruments, local anesthesia, lateral position, small openings and other techniques are used to complete the surgery. Patients are safer and more comfortable during the operation, which further improves the surgical efficacy, shortens the average hospitalization time, and reduces the economic burden of patients, and is welcomed by the majority of patients. 8.What are the precautions for lumbar disc herniation patients after discharge? The principle of rehabilitation after discharge is to consolidate the therapeutic effect, eliminate residual symptoms and prevent recurrence. Specific measures include: ① lying in a hard bed, ② moderate wear waist protection, ③ strengthen the lumbar back muscle exercise, ④ oral tonic bone pill and other drugs to consolidate the effect of treatment, ⑤ the application of neurotrophic drugs, ⑥ combination of work and rest, pay attention to labor protection to avoid recurrence.