Patient Wang, 43 years old, started to have back pain 3 years ago, now accompanied by leg numbness. Through the orthopedic, massage, exercise, recuperation has no effect, more and more serious. In the early evaluation of Wang’s condition, first to do traction, massage and so on to see the effect, but because of the habits of life and work, Xiao Li did not improve much each time, in the recent outpatient clinic, not only the symptoms have not improved, now walking has been affected, he was advised to consider surgery. For surgery Wang Mou still has many questions, and Wang Mou like many patients, their questions are summarized as follows: 1, can lumbar disc herniation conservative treatment? 2. Can it be cured? 3, because still young, afraid of major surgery to do bad, now only want to receive minimally invasive surgery, plasma cryoablation how? Answer: Cause: The cause of lumbar disc herniation is aging + strain, prolonged ambulatory work, driving, sitting in a car, housework, computer, playing cards, etc. In recent years, college students, high school students, and even elementary school students because of poor learning posture, playing computer games, early emergence of lumbar disc herniation is increasingly common. According to the census results in Northern Europe, 9% of adolescents aged 14 to 18 have a “black disc” – a degenerative disc (also known as aging). This suggests that the discs are aging much earlier than we previously thought. In the MRI of the lumbar spine in old age, the strain is mainly sitting (e.g., desk work, drafting, computers, accounting, driving, riding in cars, long-distance flights, watching TV, playing cards, knitting, etc.), or bending over to work (e.g., housework, electricians, tilers, etc.). The weight-bearing force on the lumbar spine is 1.0 when lying down, 1.5 when standing up straight and walking, and 2.5 when sitting in a forward leaning position (reading a book, computer). if you lift heavy objects, the burden will be greater. What are all the conservative treatments for herniated disc? 1, bed rest: In the conservative treatment of lumbar disc herniation, bed rest is the most important, generally accounting for 70% of the efficacy. A common misconception is that in bed, sofa “nesting” reading, watching TV, limbs in rest, the waist is still “bowed”, still strain. Say “rest”, in fact, the waist did not rest, in fact, rest is the limbs. Preferably hard bed (hard bed, hard Simmons, brown cushion can be), lying down, side, lying down can be. When lying in bed, you do not need to move, “stretching arms and legs” can be – as long as the back does not hurt. If the symptoms are not severe, you can go to the floor to eat and go to the toilet. Most of the symptoms will be relieved on their own after 3-5 days of absolute bed rest and 2-4 weeks of proper rest for the more severe cases. People with milder symptoms are not necessarily strictly bedridden and do not have to go to work. In fact, it is enough to pay proper attention to the posture and diligent activities at work. 2, other conservative treatment methods account for about 30% of the efficacy, including: orthopedic, massage, traction, physical therapy, acupuncture, cupping, plaster, oral Chinese and Western medicine, etc.. All conservative treatment methods can only relieve the symptoms and cannot correct the herniated disc, and aging is irreversible. Even surgery (including minimally invasive surgery) cannot reverse aging. Surgery is only to make the herniated disc smaller (release the compression), not to become young again. Orthopedic and massage are for back pain and are not effective for leg numbness and leg pain. Traction is effective for leg symptoms, but a common problem is that it takes a lot of effort to get to the hospital, traction for 30 minutes, and a lot of effort to get home – the strain of being on the road causes not much of the effect of traction to remain. Traction is more effective in young and middle-aged patients and less effective in older patients. Commonly used drugs: A. For milder symptoms, Chinese herbal medicine Root and Pain (blood activation) and Western medicine Microphylaxis (advanced vitamin B12). Generally, the medication is used for 1~2 weeks. B. For more severe pain, mainly rely on absolute bed rest for 3~5 days, supplemented with analgesics. For example, Fenbid (moderate), Taylanin (moderately strong), OxyContin (strong, similar to oral morphine). Take analgesics for 3~5 days, symptoms are relieved, and the drug can be reduced or stopped. C. More severe acute pain requires outpatient consultation at a major hospital or short-term use of mannitol (dehydration) or dexamethasone (hormone). D, the emergence of foot prolapse Or bowel weakness, it is necessary to emergency surgery 3, after the relief of symptoms, you need to pay attention to three things. Good posture. Computer elevated, book elevated, people sitting low, to ensure sitting straight and level-eyed. When watching TV, driving lumbar back pillow – a good sofa, car backrest are forward convex, top up the waist and neck. Hard bed when sleeping. You can ask your family and colleagues to help you correct your sitting and working habits. Diligent activity. Don’t do housework for a long time, drive, look at the computer every half hour to move, turn around, every hour to get up and walk. Strengthen the exercise of the lumbar muscles, such as breaststroke, small swallow fly (force 5 seconds, relax 5 seconds, a total of 60 times a day, no need to buckle very high, just eat on the strength). Exercise is something that happens after the symptoms get better, not when you are having a hard time, otherwise the more you exercise the harder it gets. But a common misconception is that there is usually no pain and no time to exercise. 4, do not do surgery indications, whether minimally invasive or incisional surgery, are the same: (1) cause foot drop or cauda equina nerve injury (urinary and fecal difficulties); (2) conservative six weeks ineffective severe back and leg pain, numbness, seriously affect work and life. The current standard surgical treatment at home and abroad is still the “minimally invasive” small-incision discectomy, with a 4-5 cm incision and a satisfaction rate of 80% for 15-20 years after surgery. “Minimally invasive” surgery has been the dream of physicians and patients for many years, with the hope of achieving less trauma and faster recovery. The existing methods are collagenase nucleolysis, radiofrequency nucleolysis, ozone, laser and so on. The advantage is that the incision is small (2-3 cm). But in practice, further improvement is needed —– Small incision ≠ small complications and small incision ≠ small danger. Possible disadvantages are more intraoperative radiation, less complete resection due to small incision and not direct vision, slightly higher complications, and slightly poorer satisfaction rate (European statistics 2010). In general, “minimally invasive” surgery can be used for patients with mild disc herniation and little or no bone fragmentation – especially if the herniation is not severe but the symptoms are severe. The specific choice of treatment (conservative or surgical) is up to the patient, not the physician —- who provides expertise + advice. The specific modalities and details of the procedure are determined by the physician.