The pace of life is accelerating, and there are more and more sedentary groups such as long-term ambulatory work and drivers. After ambulating or sitting for a long time, some people often have lumbar swelling and pain, and more people will have lumbar and hip pain with one or bilateral radioactive leg pain, or with numbness or even muscle atrophy in the legs or feet, walking weakness, cold skin of the calves and toes, and other discomforts. This condition may be a problem with the lumbar spine and intervertebral discs, and requires imaging examination of the lumbar spine to make a clear diagnosis. I. Anatomy and function of the spine and intervertebral discs The spine is the central axis of the bones located in the back of the cervical, thoracic and lumbar regions of the body, and is the pillar that supports the body. The vertebrae are connected together by intervertebral discs, ligaments between vertebrae, and small joints to form the spine. The spine is divided from top to bottom into five segments: cervical, thoracic, lumbar, sacral and caudal vertebrae, comprising a total of 26 vertebrae. Inside the spine, there is a longitudinally connected canal called the spinal canal, which houses the spinal cord. The intervertebral disc is a “spring cushion” located between the two vertebrae of the spine, and is a sealed body composed of cartilage plates, fibrous rings, and the nucleus pulposus. The intervertebral disc has the function of connecting the two vertebrae above and below the disc; maintaining the height of the spine; maintaining the physiological curvature of the spine; maintaining the size of the intervertebral foramen so that the nerve roots have enough space to pass through; the role of the elastic structure and the nucleus pulposus “water bladder”, which acts as a force transfer cushion. Under normal circumstances, the intervertebral discs are compressed by weight, coupled with the movement of the spine in all directions, easily causing extrusion and wear, disc degeneration is an irreversible natural process that occurs with age. Bad posture and position, such as long-term low, sedentary, standing, bending work; bad lying posture; excessive weight bearing; trauma, etc. will accelerate the degeneration of the intervertebral discs. There are 23 intervertebral discs in the human body. The disc in the lumbar region is the thickest, about 9 mm. People often say herniated disc actually refers to the lumbar disc herniation. The cervical and thoracic intervertebral discs can also be herniated, and cervical and thoracic disc herniation usually manifests as neck, shoulder and arm pain; dizziness, lightheadedness; numbness of the fingers; heartburn and chest tightness and other discomforts, and in severe cases, the spinal cord will be compressed to cause unstable walking and other symptoms. The pathogenesis and clinical manifestation of lumbar disc herniation is mainly due to the rupture of the nucleus pulposus of the intervertebral disc on the basis of degeneration by external factors such as trauma, exertion and weight bearing, and the nucleus pulposus protrudes outward from the rupture, and the protruding nucleus pulposus stimulates or compresses the nerve root and cauda equina nerve, manifesting as a series of clinical symptoms such as lumbar and leg pain, numbness and weakness of the lower limbs. 95% of intervertebral discs L4/5 and L5/S1 disc herniation causes typical sciatica, which is a radiating pain from the lower back to the buttocks, posterior thigh, lateral calf and foot. The pain is aggravated by activity, bending, prolonged sitting, prolonged standing, coughing, sneezing and other increases in abdominal pressure, mostly unilateral, but also bilateral. The pain is unbearable during acute attacks, and symptoms such as dullness of sensation, numbness and foot drop may occur in more severe cases. Third, the principle of treatment and method selection of lumbar disc herniation According to the degree of protrusion lumbar disc herniation is divided into: bulging type, protrusion type, prolapse type. The size, location and degree of protrusion are different from each other in terms of clinical performance, and the choice of treatment method is also different. Generally, the treatment principle of “simple, not complicated, conservative, not minimally invasive, minimally invasive, not surgical” is adopted. Mild pain can be treated conservatively, including bed rest, medication, traction, physiotherapy, etc. Those who are young, have the first attack or have a short course of disease, and whose symptoms can be relieved by themselves after rest, can be treated conservatively. Minimally invasive interventional surgery can be chosen if conservative treatment is not effective or if the pain is clearly intolerable. Those with huge central lumbar disc herniation with acute cauda equina injury symptoms, or those with bony spinal stenosis can choose traditional surgical treatment, surgical methods: including open window nucleus pulposus removal decompression, half/whole laminectomy nucleus pulposus removal decompression, etc. Minimally invasive technology is a new technique developed in recent years, which is a physical, mechanical or chemical treatment method under imaging guidance, local anesthesia, and precise placement of a specially designed puncture needle into/around the diseased disc tissue. These include intradiscal decompression techniques such as disc aspiration, spinotomy, plasma, laser, ozone, radiofrequency, collagenase, and foraminoscopic/posterior microscopic removal of herniated discs. Intervertebral foraminoscopy is currently recognized as the minimally invasive treatment for herniated discs with the least damage to the patient and the best results. The herniated nucleus pulposus, nerve roots, dural sac and hyperplastic bone tissue can be clearly visualized under direct endoscopic vision, and the herniated tissue is removed using various types of grasping forceps, the bone is removed microscopically, and the broken annulus fibrosus is repaired with radiofrequency electrodes. Local anesthesia, image guidance, and bright-vision operation provide definite decompression results. The orifice of only 6-7mm can achieve the same effect as traditional surgery. Fourth, the identification of common diseases causing back and leg pain: 1. What is the relationship between lumbar strain and lumbar disc herniation? There are some similarities between lumbar disc herniation and lumbar muscle strain in terms of symptoms: for example, both will have symptoms such as pain, soreness and weakness in the lower back, but they are two completely different diseases. Lumbar muscle strain is a chronic injury inflammation of the lumbar muscles and their attachment points fascia or periosteum, mostly due to chronic strain of the lumbar soft tissues caused by long-term incorrect living and working posture or long-term lumbar overload, resulting in recurrent pain in the lumbar back, usually without radiating pain of the lower limbs. 2.The relationship between discogenic lumbago and lumbar disc herniation? The difference between the two is that the former pain is confined to the lumbar region and lower limbs, but the radiating pain of the knee, while the latter is manifested as lumbar pain with radiating pain of the lower limbs distributed according to the neuropil. 3. What is the relationship between lumbar disc herniation and lumbar spinal canal stenosis? The clinical manifestations of lumbar disc herniation and lumbar spinal stenosis have many similarities and often coexist, and both are common diseases that cause low back pain or low back pain. The result of lumbar disc herniation can lead to lumbar spinal canal stenosis, but in addition to lumbar disc herniation, lumbar spinal canal stenosis may also involve bone spurs, hypertrophy of the joint capsule and ligamentum flavum, and hyperplasia of the articular eminence, which eventually leads to symptoms of compression of the nerves due to a decrease in the volume of the lumbar spinal canal that houses the cauda equina and nerve roots. CT and magnetic resonance examination can be performed for differential diagnosis. 4.Is it a lumbar disc herniation if there is no back pain but only leg pain? Patients with lumbar disc herniation usually have lumbar pain first and then leg pain. However, in some patients, the outer layer of the fibrous ring ruptures directly, and the nucleus pulposus protrudes directly or prolapses to compress the unilateral nerve roots, and the pressure on the dural sac is not obvious, so only leg pain is produced without lumbar pain. Fifth, the daily health care and prevention of the lumbar spine: 1, the choice of bed: the traditional brown bandage and other soft beds, people lying on it due to the role of weight, the body will show the central low, high corners of the state, the waist muscles continue to be in spasm, so that the intervertebral discs can not be fully rested and relaxed, very harmful to the waist. Many people sleep in this bed, the next morning after waking up will feel back pain and weakness, in the long run, very easy to cause lumbar muscle strain, can also induce lumbar disc herniation. Resting flat on a hard bed, the head, shoulders back and hips become the main pressure load-bearing point, which is conducive to maintaining the physiological curvature of the spine, but also greatly reduces the pressure load on the intervertebral discs, while also enabling the ligaments of the spine, the joint capsule of the synovial joints and the skeletal muscles around the spine to fully relax and rest. 2, the posture of sleep: to double the lower limbs slightly flexed position side lying is good, if you like supine position, you can also pad a pillow under the two knees, keeping the lower limbs slightly bent. This sleep can make the muscles of the lumbar region relaxed, which is conducive to maintaining the physiological curvature of the spine, the pressure within the intervertebral discs is also reduced, while the ligaments of the spine, the joint capsule of the synovial joints are fully relaxed rest. 3, as a fixed posture in life for no more than 30 minutes, avoid prolonged sitting, standing; lifting heavy objects should maintain the correct posture of the waist and knees. 4, pay attention to the functional exercise of the lumbar back muscles: “small swallow fly” exercise method: prone on the bed, go to the pillow, hands behind the back, force the chest to lift the head, so that the head and chest out of the bed, while the knee joint straightened, the two thighs force backward also leave the bed, for 3 to 5 seconds, and then muscle relaxation rest 3 to 5 seconds for a cycle. “Five-point support” exercise method: lie on your back in bed, go to the pillow and bend the knees, both elbows and back against the bed, abdomen and hips up, relying on the shoulders, elbows and feet of the five points to support the weight of the whole body, for 3 to 5 seconds, and then relax the lumbar muscles, put down the hips to rest for 3 to 5 seconds for a cycle. Schematic of the lumbar back muscle exercise method The method, number of times and intensity of exercise selection: according to their actual situation, choose the appropriate method for their exercise. The number of times and intensity should vary from person to person, and can be practiced more than ten times a day, divided into 3 to 5 groups to complete. Should be gradual, gradually increase the amount of exercise; such as exercise the next day after the lumbar pain, discomfort, stiffness, etc., should be appropriate to reduce the intensity and frequency of exercise, or stop exercise, so as not to aggravate the symptoms; exercise do not suddenly force too hard; in the acute attack of low back pain should be timely rest, stop practice, otherwise, may make the original symptoms aggravated.