Herniated Lumbar Disc A herniated disc is a disc in which the fibrous annulus of the intervertebral disc ruptures and the nucleus pulposus tissue protrudes (or prolapses) from the rupture into the posterior or spinal canal. It is really just a pathologic change, or imaging manifestation, almost an indispensable part of the human aging process, just as wrinkles on the face and graying of the hair are common, and it is not a disease. According to the literature, the incidence of lumbar disc herniation is high in asymptomatic people. In one study, MRI scans were performed on 102 asymptomatic volunteers, ages 14-82, with an average of 46.3 years, and the rates of disc herniation, annulus fibrosus tears, and nucleus pulposus degeneration were found to be 81.4%, 76.1%, and 75.8%, respectively. A study published in JBJS showed that more than 20% of asymptomatic volunteers under the age of 60 had herniated discs, and a study in Spine showed that 40% of asymptomatic volunteers under the age of 30 had degenerated discs, with the rate rising to 90% in volunteers aged 50-55. Long-term follow-up studies have found no correlation between the presence of herniated discs and the subsequent presence and duration of low back pain in these volunteers. Lumbar disc herniation Lumbar disc herniation, on the other hand, is a clinical syndrome in which a herniated lumbar disc leads to irritation or compression of the adjacent spinal nerve roots, resulting in a series of symptoms such as lumbar pain, numbness, and pain in one or both lower limbs. In fact, in the English literature and monographs, there is no such term as lumbar disk herniation, but “sciatica” (sciatica) and “lumbar disk herniation” (lumbar disk herniation) are two words that appear with high frequency in the literature, and many contexts are probably similar to the Chinese term “lumbar disk herniation”. In many contexts, it is probably similar to the Chinese term “lumbar disc herniation”. Of course, there is also the expression “asymptomatic lumbar disc herniation”. Prof. McCulloch is a landmark figure in the study of lumbar degenerative diseases, and the diagnostic criteria he proposed have been used to this day: (1) leg pain is greater than lumbar pain, and is mainly confined to the area innervated by the sciatic nerve or the femoral nerve; (2) sensory abnormality in the dermatomal area; (3) a positive straight-leg elevation test, with an angle of less than 50% of the normal angle or a positive straight-leg elevation test on the healthy side; (4) two out of four of the four criteria, including muscular atrophy, weakness, sensory loss, and tendon reflex weakness, have been used to describe asymptomatic lumbar disc herniation. Muscle atrophy, weakness, hypesthesia, and decreased tendon reflexes; ⑤ Imaging features that are consistent with the clinical presentation. According to the above diagnostic criteria and the pathological characteristics of lumbar disc herniation, lumbar disc herniation must not only have the pathological changes of lumbar disc herniation (imaging manifestations), but also must have the clinical manifestations of damage to the corresponding neurological structures, and pain and numbness with the characteristics of rhizomatic distribution. Therefore, even if there is an obvious lumbar disc herniation on imaging and there is also regional pain in the lumbar region, buttocks or thighs, it is questionable to diagnose lumbar disc herniation if there is no pattern of radicular distribution of nerves. Must I stay in bed for conservative treatment of lumbar disc herniation? Most of the domestic monographs, Chinese literature, and even textbooks advocate strict bed rest for conservative treatment of lumbar disc herniation. However, from searching the English literature, we found that this is not the case. Spine, the most authoritative journal of spinal surgery, has published a Cochrane systematic review with the highest level of evidence in evidence-based medicine, concluding that bed rest is recommended for patients with acute low back pain with fewer benefits (pain, functional rehabilitation) compared to continuing daily activities, and that there is little or no difference in patients with lumbar herniated discs between bed rest and remaining active. There is a large body of literature that agrees with the above, and few studies have been reported that advocate strict bed rest. It is clear that bed rest is not necessary, and if the patient’s pain and dysfunction are not so severe that it is difficult to move an inch, there is no need to artificially limit his or her activities and strictly require bed rest. Surgical indications for lumbar disc herniation There is no uniform opinion on this. But should surgery be performed if there are typical neurological symptoms and signs? From the viewpoint of NEJM, BMJ and other high-quality literature, surgery can be considered for the following patients: patients with a clear diagnosis of lumbar disc herniation with cauda equina syndrome or acute severe local paralysis or progressive aggravation of paralysis; accompanied by intractable radicular nerve pain (which can not be relieved by morphine) or can not be relieved by systematic conservative treatment for 6-8 (12) weeks. Overall, surgery is safe, with a lower complication rate, and symptoms usually improve faster and to a greater extent with surgery; but non-surgical procedures are also safe, except in the case of cauda equina syndrome and progressive exacerbation of neurologic damage, when non-surgical treatment is chosen, and ultimately, a better outcome can be achieved. This means that most discectomies can be avoided without any long-term damage. If the symptoms are intolerable, surgery may be considered if an early recovery is desired. For patients who have a herniated lumbar disc with non-specific low back pain, please do not cut the disc in the name of lumbar disc herniation.