I. Overview Lumbar disc herniation refers to a series of symptoms caused by the protrusion of the nucleus pulposus of the lumbar intervertebral disc and compression of its surrounding nerve tissue, which is a relatively common clinical pain in the back and legs, mainly due to degenerative changes of various parts of the lumbar intervertebral disc (nucleus pulposus, fibrous ring and cartilage), especially the nucleus pulposus to varying degrees, under the action of external factors, the fibrous ring of the intervertebral disc ruptures, and the nucleus pulposus tissue protrudes from the rupture (or prolapse) in the posterior or vertebral canal, resulting in adjacent tissues, such as spinal nerve roots, spinal cord, etc. suffer from stimulation or compression, resulting in lumbar pain, numbness and pain in the lower extremities or both lower extremities, numbness and tingling in the perineum due to compression of the cauda equina nerve, urinary and bowel dysfunction, urinary incontinence in women, impotence in men, loss of control of urination and defecation in severe cases and incomplete paralysis of both lower extremities, and a series of clinical symptoms The symptoms of lumbar disc herniation include Classification of lumbar disc herniation: Lumbar disc herniation can be classified according to the direction of the herniated nucleus pulposus: (1) unilateral lumbar disc herniation, which generally produces symptoms on only one side of the lower limbs. (2) Bilateral lumbar disc herniation, which produces bilateral lower extremity symptoms. (3) Central type lumbar disc herniation, which can compress the cauda equina nerve, manifesting as perineal paralysis and symptoms of urinary and fecal disorders. The main change is the dehydration of the nucleus pulposus, after which the disc loses its normal elasticity and tension, and on this basis, due to heavy trauma or repeated inconspicuous injuries, the fibrous ring becomes weak or ruptures, and the nucleus pulposus protrudes from the area, compressing the nerve root and producing nerve root injury. The nucleus pulposus protrudes from the nerve root, compressing the nerve root and causing nerve root injury. If the fibrous ring ruptures completely, the broken nucleus pulposus enters the spinal canal, causing extensive damage to the cauda equina. Since the lower lumbar region is heavily loaded and has many activities, herniation mostly occurs in the lumbar 4-5 and lumbar 5-sacral 1 spaces. Fourth, the symptoms of lumbar disc herniation 1, lumbar pain and one side of the lower limb radiating pain is the main symptoms of lumbar disc herniation. Low back pain often occurs before leg pain, or both can occur at the same time; most of them have a history of trauma, and there can be no clear cause. The pain has the following characteristics: A radiating pain is transmitted along the sciatic nerve and reaches the lateral calf, dorsum of the foot or toes. In the case of lumbar 3-4 interstitial herniation, radiating pain to the front of the thigh is produced due to compression of the lumbar 4 nerve root. B All actions that increase the pressure of cerebrospinal fluid, such as coughing, sneezing and defecation, can aggravate the lumbago and radiating pain. C Pain increases with activity and decreases with rest. Bed position: Most patients are in lateral recumbency with flexion of the affected limb; individual severe cases have pain in all positions and can only bend the hip and knee in bed to relieve symptoms. In combination with lumbar spinal stenosis, there is often intermittent claudication. 2, scoliosis deformity: the main bend in the lower back, more obvious when forward bending. The direction of scoliosis depends on the relationship between the herniated nucleus pulposus and the nerve root: if the herniation is located in front of the nerve root, the trunk is generally bent to the affected side. 3, restricted spinal activity: the nucleus pulposus protrudes, compressing the nerve roots and causing protective tension in the lumbar muscles, which can occur unilaterally or bilaterally. As a result of lumbar muscle tension, the physiological anterior convexity of the lumbar spine disappears. The anterior flexion and posterior extension activities of the spine are restricted, and radiating pain to one lower limb can occur during anterior flexion or posterior extension. 4. Lumbar pressure pain with radiating pain: there is a limited pressure pain point next to the spinous process on the affected side of the disc herniation site, and it is accompanied by radiating pain to the calf or foot. V. Diagnosis and examination of lumbar disc herniation Most patients with lumbar disc herniation can be correctly diagnosed based on clinical symptoms or physical signs. X-rays should be taken for the frontal and lateral views of the lumbosacral spine and, if necessary, for the left and right oblique views. x-ray signs cannot be used as a basis for confirming the diagnosis of lumbar disc herniation, but they can be used to exclude some disorders. When there is difficulty in diagnosis, special examinations such as spinal iodine oil imaging, CT scan and MRI can be considered to clarify the diagnosis and the site of herniation. Patients with no obvious abnormalities in the above examinations are not completely excluded from lumbar disc herniation. Treatment of lumbar disc herniation (a) Non-surgical treatment of lumbar disc herniation. Rest on a hard bed, supplemented by physical therapy and massage, can often be relieved or cured. Prone traction is easy to reset by shaking, and the cure rate is high and easily accepted by patients, which is the commonly used non-surgical treatment. (B) Surgical treatment. The indications for lumbar disc herniation surgery are: ① Non-surgical treatment of lumbar disc herniation is ineffective or recurrent, and the symptoms are heavy and affect work and life. (2) Those who have obvious and extensive symptoms of nerve damage, or even continue to deteriorate, and are suspected of having complete rupture of the disc fibrous ring and protrusion of the nucleus pulposus fragment into the spinal canal. ③Those with central type lumbar disc herniation who have urinary and fecal dysfunction. (iv) Those with lumbar disc herniation combined with obvious lumbar spinal stenosis. Heavy physical work should be avoided for six months after surgery.