Lumbar disc herniation Lumbar disc herniation is one of the more common lumbar disorders in clinical practice, and is a common and frequent disease in orthopedics and traumatology. The lumbar disc exists between the vertebrae of the lumbar spine and is an integral part of the lumbar spine joints, playing a supporting, connecting and cushioning role for the lumbar spine vertebrae, which is shaped like a flattened abacus bead and consists of the nucleus pulposus, cartilaginous plate, and fibrous ring. When the annulus fibrosus bulges back or breaks due to trauma or degeneration, and the nucleus pulposus comes out, it is called a lumbar disc herniation. Since the spinal cord passes behind the intervertebral disc, when the protruding intervertebral disc presses on the spinal nerve or cauda equina nerve, causing lumbar and leg pain or incontinence, or even causing paralysis, it is called lumbar disc herniation. Lumbar intervertebral disc is located between two adjacent vertebrae, there are inside and outside, outside the two parts of the composition, the external for the annulus fibrosus, composed of multiple layers of annular arrangement of fibrocartilage ring, around the nucleus pulposus, can prevent the nucleus pulposus outward protruding, the fibers are tough and elastic; the internal for the nucleus pulposus, is a kind of elastic gelatinous material, there is a role in moderating the impact. Adults, degenerative changes in the intervertebral disc, the fibers in the annulus fibrosus becomes thicker, glass degeneration occurs so that the final rupture, so that the intervertebral disc loses its original elasticity, can not bear the original pressure. In the case of overstrain, sudden change of body position, violent movement or violent impact, the annulus fibrosus can bulge outward, and thus the nucleus pulposus can be protruded outward through the fissure of the ruptured annulus fibrosus, which is the so-called lumbar herniated disc. Lumbar disc herniation, according to the degree of herniation can be divided into: 1, disc bulging (bulging): the most minor. The annulus fibrosus of the intervertebral disc is uniformly beyond the range of the intervertebral space, and the intervertebral disc tissues are not limited to protrusion. 2. Protruded disc: moderate. The intervertebral disc tissue is displaced beyond the intervertebral space in a limited manner. The displaced intervertebral disc tissue is still connected to the original intervertebral disc tissue, and the diameter of its basal continuum is larger than that of the displaced intervertebral disc portion beyond the intervertebral space. 3. Extruded disc: Severe. The displaced disc tissue is larger in diameter than the basal continuum and has moved beyond the intervertebral space. The prolapsed disc tissue is larger than the ruptured intervertebral disc space, and is located in the spinal canal through this gap. Clinical manifestations (1) Low back pain Most patients have a history of low back pain for weeks or months, or a history of recurrent low back pain episodes. The degree of lumbar pain varies in severity, and in severe cases it can affect turning over and sitting up. Generally, the symptoms are alleviated after rest, and coughing, sneezing or straining during bowel movements can aggravate the pain. (2) Lower extremity radiating pain Radiating pain in the sciatic nerve region of one side of the lower extremity is the main symptom of this disease, often appearing when the lumbago disappears or decreases. The pain starts from the buttocks and gradually radiates to the back of the thigh, the outer side of the calf, and in some cases to the back of the foot, the heel or the ball of the foot, affecting standing and walking. If the protrusion is in the center, it is in the cauda equina symptoms, and bilateral protrusion, the radiation may be bilateral or alternating. (3) Lumbar mobility disorder Lumbar mobility is affected in all aspects, especially obvious in posterior extension disorder. In a few patients, forward flexion is obviously limited. (4) Scoliosis Most patients have varying degrees of lumbar scoliosis. The direction of scoliosis can indicate the location of the protrusion and the relationship of the nerve root. (5) Numbness of the lower limbs Those with a longer course of the disease often have subjective numbness. It is mostly confined to the posterior-lateral calf, dorsum of the foot, heel or ball of the foot. (6)Temperature drop of the affected limbs Many patients feel cold in the affected limbs, and on objective examination, the temperature of the affected limbs is lower than that of the healthy side; some dorsalis pedis arterial pulsation is also weaker, which is due to the sympathetic nerve stimulation. This is due to sympathetic nerve stimulation. It must be differentiated from embolic arteritis. The main causes of lumbar disc herniation are internal and external, the main internal cause is degenerative changes of lumbar vertebrae; external causes include trauma, strain or overwork, cold and dampness, etc. In addition, it is related to age, height and heredity. In addition to age, height, genetics, pregnancy, smoking: diabetes, etc. Common predisposing factors ① increased abdominal pressure, such as coughing, constipation, defecation and so on. ② improper lumbar posture, when the waist is in a flexed position, if suddenly rotated, it is easy to induce herniation of the nucleus pulposus. ③ Sudden weight bearing, in the absence of adequate preparation, sudden increase in the lumbar load, easy to cause herniation of the nucleus pulposus. Trauma to the lumbar region, acute trauma can affect the fibrous ring, cartilage plate and other structures, and promote the degeneration of the herniated nucleus pulposus. Occupational factors, such as long-term driving, sedentary people, easy to induce disc herniation. Auxiliary examination: Frontal and lateral radiographs of lumbosacral vertebrae should be taken. When there is difficulty in diagnosis, special examinations such as CT scan and magnetic resonance may be considered to clarify the diagnosis and the herniated part. Patients with no obvious abnormality in the above examinations are not completely excluded from lumbar disc herniation. Lumbar disc herniation should be distinguished from the following diseases 1. Lumbar spinal stenosis Intermittent claudication is the most prominent symptom. Patients complain that after walking for a certain distance, their lower limbs are aching, numb and weak, and they have to squat down to take a rest before they can continue to walk. The patient must squat and rest before continuing to walk. Bicycling can be asymptomatic. 2, lumbar isthmus fissure slip 3, lumbar spine tuberculosis 4, lumbar spine tumor 5, lumbar spine intravertebral canal tumor Conservative treatment: bed rest as the main conservative treatment method, other conservative methods include drug therapy, physical therapy, acupuncture. 1, non-steroidal analgesics such as anti-inflammatory pain, ibuprofen, etc., analgesic effect is strong, anti-inflammatory and anti-rheumatic effect is also strong. However, generally anti-inflammatory analgesics can not be taken for a longer period of time, especially for patients who also suffer from liver/kidney disease, hypertension, diabetes should pay more attention to the contraindication, so as not to cause new discomfort. 2.Central muscle relaxants: such as Myrna. 3.Neurotrophic drugs: e.g. Microphenol, etc. 4, Chinese medicine, ointment 5, physical therapy: such as massage, hot packs, cupping, etc. 6, traction therapy 7, surgical treatment Surgical treatment: Surgical indications: ① non-surgical treatment is ineffective or recurrence, the symptoms of the heavier impact on the work and life. ② nerve damage symptoms are obvious, extensive, or even continue to deteriorate, it is suspected that the intervertebral disc annulus fibrosus completely ruptured nucleus pulposus fragments protruding into the spinal canal. (iii) Central lumbar disc herniation with urinary and fecal dysfunction. (iv) Combined with obvious lumbar spinal stenosis. Surgery: Minimally invasive surgery (intervertebral discoscopic nucleus pulposus removal), open surgery nucleus pulposus removal.