1.What is lumbar disc herniation? Lumbar disc herniation is a group of syndromes related to lumbar disc herniation, usually including: lumbar pain, low back pain, radiating pain or numbness in lower limbs, and in a few severe cases, urinary and fecal dysfunction or sexual dysfunction. 2.What is the cause of lumbar disc herniation? At present, it is generally believed that lumbar disc herniation is a type of disease related to degenerative spinal lesions (i.e. aging), i.e. aging of the body is an important cause of this disease. Most people believe that lumbar disc herniation is associated with heavy physical work or lumbar sprain, which is not entirely correct. In recent years, studies on twin brothers (sisters) have revealed that lumbar disc herniation is still a disease determined by the patient’s own physical qualities, i.e., it is related to the patient’s genetic phenotype, with environmental factors playing a secondary role. It was found that smoking, obesity and other factors are related to the onset of lumbar disc herniation. 3.What are the clinical manifestations of lumbar disc herniation? Low back pain with radiating pain in the lower extremities is a typical manifestation of lumbar disc herniation, but low back pain and leg pain may not both manifest at the same time, and some patients may have no severe pain but show numbness in specific areas of the legs. Since lumbar disc herniation can coexist with lumbar spinal stenosis, or lumbar spondylolisthesis, or lumbar instability, sometimes the symptoms are more complex, for example, they can manifest as shortened walking distance and weakness in both legs. These need to be determined by professional doctors combined with the necessary examinations. 4.Does frequent back pain mean that I have lumbar disc herniation? There are many causes of low back pain, and frequent low back pain does not necessarily mean lumbar disc herniation. Clinically, only about 30% of low back pain can be identified as the cause, of which lumbar disc herniation accounts for an even smaller portion. If there is persistent, or recurrent, low back pain of a similar nature, it is important to be alert, especially if there is significant nocturnal pain, and it is recommended that a specialist spine surgeon be consulted as soon as possible. Most of the usual intermittent low back pain is often related to poor posture, mainly due to chronic fatigue and inflammatory response of the lumbar musculature, and need not be overly concerned. 5.How to diagnose lumbar disc herniation? The diagnosis of lumbar disc herniation is mainly based on clinical symptoms, and imaging examinations, including MRI, CT, X-ray, etc. are all auxiliary examinations. 6.What are the conservative treatments for lumbar disc herniation? More than 90% of lumbar disc herniation requires only conservative treatment. Reasonable conservative treatment includes: education on basic knowledge of lumbar disc herniation (to help relieve psychological burden), smoking cessation, bed rest for a short time (1~2 days), avoidance of bad posture or stimulation (prolonged sitting, prolonged bending, weight-bearing), maintenance of normal living and working conditions as far as possible, whole-body exercise and aerobic exercise within one’s ability. Exercise, reasonable drug treatment (anti-inflammatory and analgesic drugs, etc.). Evidence-based medical research shows that the role of various physical therapy and traction is limited. Manual massage and acupuncture have a certain effect, but the duration of treatment should not be too long, generally not more than 12 weeks. 7.In what cases should surgery be considered? More than 90% of lumbar disc herniation can be significantly relieved in about 1 month after conservative treatment, even without special conservative treatment. However, there are a small number of patients whose symptoms cannot be relieved or cannot be relieved to meet normal life, then surgery may be required. The current clinical indications for surgery are that regular conservative treatment is ineffective for 6 weeks and the symptoms cannot be relieved, which seriously affects the patient’s life or work, before surgery is considered. For patients with urinary and fecal disorders and numbness around the anus after the onset of the disease, surgery should be recommended as soon as possible, because this is a manifestation of damage to the cauda equina nerve, and once the cauda equina nerve is damaged, then it is more difficult to recover. 8.What are the current scientific and reasonable surgical treatment techniques? The current surgical treatment techniques for lumbar disc herniation also develop a series of techniques according to the different conditions of lumbar disc herniation. For young patients with the majority of the disc structure still intact, minimally invasive and non-fusion surgical techniques are advocated, such as: microscopic nucleus pulposus removal surgery, lumpectomy nucleus pulposus removal technique, small incision non-fusion technique, etc. In cases of huge disc herniation, calcified disc herniation, accompanied by lumbar instability, etc., fusion internal fixation is mostly used. Fusion fixation of the lumbar spine is called the “gold standard” technique, which has the advantages of positive efficacy, early return to normal movement after surgery, and avoid recurrence. 9.Is the minimally invasive surgery for lumbar disc herniation introduced on TV and newspapers really an advanced and safe technology? Minimally invasive surgery for lumbar disc herniation is currently introduced on TV and in many media such as newspapers. Minimally invasive surgery is certainly a development direction of lumbar spine surgery, such as various lumpectomy techniques and non-fusion techniques belong to the category of minimally invasive surgery. However, many minimally invasive surgeries currently advertised in the society are actually not advanced and scientific techniques, for example: chemical enzyme ablation of intervertebral discs, which has been eliminated abroad for many years. Some ozone therapy and radiofrequency ablation treatments are invasive in developed countries and have a strictly defined scope of treatment, but some hospitals in China lack the cooperation of spine specialists and blindly carry out treatment in many cases. Clinical examples of aggravation and complication due to inappropriate treatment are common. 10.How to avoid getting lumbar disc herniation? The golden rule to avoid getting lumbar disc herniation is to use your back in a reasonable manner. Research has found that the force on the lumbar disc is minimal when the person is in the prone position, the force on the lumbar disc in the standing position is four times that of the prone position, and at least six times that of the prone position when sitting. Therefore, usually avoid sitting for a long time. In fact, the human body has an early warning device to avoid excessive strain on the waist, will from time to time issue a warning signal – that is, “waist soreness and sleepiness”. When we work at the desk, a period of time after the waist soreness and sleepiness, we are reminded that we should get up and activities, let the waist rest. If this signal is ignored, the long-term result will be accelerated aging of the intervertebral discs, accompanied by structural and chemical changes. In addition, active whole-body exercise and aerobic exercise can help improve the functional state of the lumbar discs. 11.Does it matter if a lumbar disc herniation is found on imaging? After the age of 35, all organs begin to move from their peak to the path of gradual aging and decline, and the lumbar disc is no exception. Some people feel very nervous when they find a herniated or bulging lumbar disc during physical examination, in fact, it is not necessary, the changes in the image does not mean that there must be a problem with the lumbar disc, which is like the wrinkles on our face and gray hair on our head as we age, even the occasional lumbar pain and lumbago and disc herniation are not necessarily directly related, but only to remind us that we should be more healthy and reasonable with the waist.