What happened to the “herniated lumbar discs” Today, after sorting through the posts about “herniated lumbar discs”, it is unfortunately difficult to come up with a post that can serve as a model for a comprehensive understanding of this common condition. Most of these postings do not provide complete clinical information, and frankly some of my answers are tinged with certain emotions, emotions called “hopelessness”, why? The actual “lumbar disc herniation” diagnosis and treatment misconceptions. The people’s hospital in Jimo City orthopedic surgery department (spinal surgery) Ren Shou Song Therefore, in addition to putting together a post with reference value, I also wrote out the problems I have often encountered over the years in the diagnosis and treatment of “lumbar disc herniation”, in the hope that it can be helpful to everyone. I hope that those who are worried about suffering from “lumbar disc herniation” and those who have already suffered from “lumbar disc herniation” will read this post and find it helpful so that you will be less confused and overwhelmed. The concept of lumbar disc herniation: The first thing to make clear to you is that “lumbar disc herniation” and “lumbar disc herniation” are two completely different concepts. Lumbar disc herniation: It is a “protruding” form of the lumbar intervertebral disc that manifests itself in the spatial configuration or imaging, which is mostly defined as the volume of the intervertebral disc exceeding the volume of the vertebral bones in the same segment. Not to mention the accuracy of this perception (it is sometimes reasonable for the disc to exceed the volume of the vertebral body of the same segment in the physiological state because of its elasticity and deformability), even if this statement is correct, this “disc herniation” on imaging can occur in normal people. In reality, there are several situations that often arise: First, when a patient has low back pain, the physician does not examine the patient carefully or is not very careful about low back pain, and recklessly selects a CT examination for the patient. Some medical units even choose CT examinations for the majority of patients with low back pain, which can also cater to the psychological needs of most patients and increase the income of medical units, a win-win situation. However, no one is asking the question: Does this patient really need a CT test? No patient asks himself whether he really needs it when he chooses a CT test. The vast majority of patients believe that CT is an advanced test and that I don’t want a regular film, I want CT, and many believe that they even need a “more advanced” test like MRI because it will “see better”. Many patients believe that they even need a “more advanced” test like an MRI because it will “see better. The second and more common scenario is when a patient comes to the clinic and says, “Doctor, I have back pain, please give me a CT test. Otherwise, the doctor has to take great pains to convince the patient to have a physical examination first, and if it is found that it is not a “lumbar disc herniation”, he or she has to take great pains to convince the patient to change his or her “preconceived” notion and give up the CT examination. This process can be very difficult and risky. Why? Because in case a patient has a CT test at another hospital in the future and finds some problems, he may come to the hospital to get in trouble with the doctor, and perhaps in rare cases, there may be a real possibility of misdiagnosis. Based on these concerns, many doctors will comply with the patient’s request and give him a CT examination. If there is no problem with the CT examination, it is fine to explain, but if there is a “herniated disc” on the CT, the next explanation is a more laborious process. The most worrying thing is to blame all the back symptoms on this so-called “lumbar disc herniation”, which on the one hand ignores the real cause of back pain, and on the other hand leads to inappropriate treatment for this “disc herniation”, increasing the economic burden and increasing the mental burden. The problem is that the “herniated lumbar disc” is not only a problem, but also an aggravation of the burden of thought, and henceforth wears the hat of “herniated lumbar disc” for several years or even more than ten years. You should never, ever be eager to pay attention to whether the doctor will give you the kind of examination you expect, you must always listen to what the doctor says to you first, this is actually very difficult to do, why? But I still strongly advise you to always force yourself to listen to the doctor who is seeing you first, unless you absolutely do not trust him, then you can actually not register with him at all. Please believe that more than 90% of the doctors in specialist clinics are doctors with deep experience and professionalism in their specialty. In many cases, the information you first encounter is not necessarily the most accurate information. Patients first need to be clear: all machine tests require a human being to operate, and even more so to interpret the results and recognize them. The diagnosis of diseases always requires the doctor to communicate with the patient in detail to obtain first-hand clinical information, that is, the collection of medical history, and equally important is the doctor’s physical examination of the patient, which can be said to be the only means of diagnosing all diseases since ancient times. Chinese medicine emphasizes “looking, smelling, asking and feeling”, while Western medicine emphasizes “seeing, touching, tapping and listening”, which means that the doctor’s judgment is the only way to make a diagnosis, and it will never be a machine. One day, a patient came to my office and said right away that he had a “herniated disc” and asked for a CT examination. The bad thing is, my serious and scholarly spirit came up, and as the saying goes, I was guilty of “shafting” and asked two more questions inappropriately, “How do you know you have a herniated disc? Do you have pain in your legs? I said that it was better to let the doctor see the doctor first and then let him choose the examination method, so as not to be blind and do the examination that should not be done. What I didn’t expect was that she turned pale and thought I was “lecturing” her, saying that she had come to see a doctor, not to hear me lecture her. I had to apologize and explain that it was not a lecture, but my own true thoughts, and that I was thinking of the patient to make the diagnosis more efficient. Nevertheless, the harmony between the doctor and the patient was gone, so I had to stop “talking nonsense” and dutifully prescribed a CT test for her. I told her that it was not a big problem and that she had finally achieved her goal. I did not bother to examine the body carefully and prescribed a few medicines in her mind and watched her leave the clinic. I didn’t have to go to the hospital monitoring office to complain about me, so it was close. But I don’t know how well she knew about her condition and whether she got the right information. At many times I have been thinking about the problem of sticking to my correct diagnosis and treatment, not easily submitting to the patient’s misconceptions, making it a hassle to see the patient and not ending up well, so why bother? Wouldn’t it be better to comply with the patient’s psychology, give him a film, give him a CT, prescribe some random medicine, and get a relaxation for yourself? But what about me? As a spine surgeon, what about me? Where is my responsibility? So, still in pain, still laboring. We are getting further and further away from the topic. Now let’s talk about “lumbar disc herniation”, where the word “disease” is added and it becomes a disease. The lumbar disc herniation is a degeneration or rupture of the lumbar disc, the nucleus pulposus of the disc protrudes and compresses the nerve, resulting in back pain, leg pain or cauda equina symptoms. Because herniated lumbar discs most often occur in the lumbar 4/5 and lumbar 5/sacral 1 segments, which are the two lowest segments of the lumbar spine, and the nerve roots that are compressed mainly comprise the sciatic nerve, most leg pain caused by a herniated lumbar disc is actually considered to be sciatica. For those leg pains that do not fit the characteristics of sciatica, the cause is often not a herniated disc. The diagnosis of “lumbar disc herniation” requires the following elements: 1. clinical manifestations of lumbar disc herniation such as low back pain and sciatica 2. physical examination with manifestations of sciatic or cauda equina nerve compression, such as loss of sensory function, motor function, and nerve reflexes 3. ancillary examinations that can confirm the presence of a herniated disc, and Sciatica is a typical symptom in which the pain is transmitted along the buttocks to the lower extremities, with radiating pain. There is also numbness on the lateral or posterior side of the calf. Coughing or defecation can aggravate the symptoms. The pain in the front of the thigh is not sciatica, and the pain in the inner and outer thighs is not sciatica. Along with sciatic nerve irritation symptoms, many patients will experience weakness and limpness in the lower extremities, mainly weakness in lifting the toes on the cam of the foot or weakness in lifting the heel. The following conditions cannot be diagnosed as lumbar disc herniation: 1. Pure imaging findings of a herniated disc without clinical manifestations of disc herniation 2. 4. Although there are elements for the diagnosis of “lumbar disc herniation”, if there are other symptoms such as fever and resting pain (not relieved by rest), the possibility of other diseases should be considered, such as tuberculosis and tumor, etc. The most common cause of lumbar pain in clinical practice is actually not Lumbar disc herniation, which accounts for only a small percentage of lumbar disc herniation, so why does it appear that all patients consider the disease as soon as they develop low back pain? There are many reasons, but misleading advertising and commercialization of disc disease treatment is an important factor, other factors are the misuse of CT and MRI examinations and the limitation of doctors’ diagnostic level. Many patients ask about the treatment of “herniated disc”, so here is a brief description. In other words, what we are treating is the “disease” and not the abnormal findings on the examination. More than 80% of patients can get relief or long-term relief through non-surgical treatment, and there are many, many methods, which can also be very confusing. I think about this point, many patients are not thought of. They are for the “ultimate method”, “magic method”, “root cause method” diligently sought, this idea is understandable, but the disease is neither a cure, nor a panacea. Bed rest can relieve the pressure on the intervertebral discs, reduce the nerve root compression, reduce the inflammation of the nerve root, and thus significantly relieve the symptoms. 2, medication, anti-inflammatory and analgesic drugs, Chinese medicine and neurotrophic drugs 3, traction or tui na, manipulative therapy, to be used with caution, there are cases of aggravation of symptoms leading to disc prolapse 4, epidural closure therapy 5, percutaneous puncture, the use of aspiration, nucleolysis, radiofrequency, laser, ozone and other methods to do intervertebral disc decompression After more than three months of non-surgical treatment is ineffective, severe pain affects work and life, and the pain is not relieved. If the pain cannot be relieved by bed rest, muscle atrophy of lower limbs, muscle weakness and limb dysfunction occur, these cases should be considered for surgical treatment. In the case of cauda equina symptoms such as urinary and fecal dysfunction and sexual dysfunction, immediate surgical treatment is required. The surgical method is based on simple discectomy, and individual patients require simultaneous intervertebral fusion surgery. For discectomy, most surgeons use the traditional open revealing technique, which has been used for nearly 100 years with definite and positive results. In the last 10 years, a few doctors (like me) have been performing discectomies using a small incision endoscopic technique, also known as “discectoscopy”, with an incision of 2 cm or less, which avoids excessive muscle stripping and damage to vertebrae and other structures, reduces surgical trauma, and shortens hospital stays and costs. The disadvantage is that the technique is difficult and not widely available. In summary, “lumbar disc herniation” is a term that has been abused, and there are many misunderstandings in diagnosis and understanding, and confusion in treatment, causing confusion to many patients. The propaganda that a certain drug can “cure lumbar disc herniation” and “completely say goodbye to surgery” is ridiculous, unscientific and not worth arguing with.