I. What is lumbar disc herniation? Lumbar intervertebral disc herniation is a relatively common clinical lumbar disease, mainly because the lumbar intervertebral disc components (nucleus pulposus, fibrous ring, cartilage plate), especially the nucleus pulposus, after various degrees of degenerative disease, under the action of external factors, the intervertebral disc fibrous ring rupture, the nucleus pulposus tissue from the rupture protrude (or prolapse) in the posterior (lateral) or spinal canal, resulting in adjacent tissues, such as spinal nerve and spinal cord This causes the adjacent tissues, such as spinal nerves and spinal cord, to be stimulated or compressed, resulting in a series of clinical symptoms such as low back pain, numbness and pain in one or both lower limbs. Xie Chuankui, Department of Surgery, Anqing Third People’s Hospital The causes of lumbar disc herniation are: (1) degenerative lesions of the lumbar intervertebral disc; (2) the role of external forces: in daily life and to work, many people have long-term lumbar improper force, excessive force, incorrect posture or position, etc.. For example: stevedores bend over for a long time to lift heavy objects, clerical workers or drivers are in a sitting position or bumpy state for a long time. These repeated external forces cause minor damage to the lumbar intervertebral disc over time, increasing the degree of degeneration. (3) The weakness of the disc’s own anatomical structure: A. The disc gradually lacks blood supply in adulthood, and its repair ability is poor, especially after degeneration, the repair function is somewhat impotent. b. The posterior lateral fibrous ring of the disc is weak, and the posterior longitudinal ligament in the lumbar 5 sacral 1 plane has significantly reduced in width, and the strengthening effect on the fibrous ring is significantly weakened. The above-mentioned effects are predisposing factors that lead to a sudden increase of the intervertebral disc with pressure and may cause disc herniation. Predisposing factors can be: 1. Sudden weight bearing or flashing back. Sudden increase in lumbar load, especially rapid bending and lateral flexion or rotation, is the main cause of formation of rupture of the annulus fibrosus. 2, trauma to the lumbar region. When the violence is strong and does not cause fracture dislocation, it is possible to make the degenerated nucleus pulposus protrude. In addition, lumbar puncture examination or lumbar anesthesia may also produce disc protrusion. 3, improper posture, in daily life and some work such as getting up, standing up, if the waist is in a flexed position, suddenly give an additional rotation action, it is easy to induce the nucleus pulposus protrusion. 4, increased abdominal pressure. Research shows that abdominal pressure and disc protrusion have a certain relationship, sometimes even in the violent cough, sneeze, ambassador secret knot, force breath can also occur herniated nucleus pulposus. 5, cold and moisture. Cold or damp can cause small blood vessel constriction and muscle spasm to increase the pressure on the disc, which may also cause rupture of the degenerated disc. Third, lumbar disc herniation is common in whom? Lumbar disc herniation has a certain tendency to occur, in general, in the following people: age: the disease occurs in people aged 25-50 years old, accounting for more than 75% of the overall incidence, although this age is a person’s young and strong period, but, is the degeneration of the intervertebral disc has begun. Gender: lumbar disc herniation is mostly seen in men. This is due to the fact that the proportion of men engaged in physical labor in social work is greater than that of women, and the lumbar disc load is also greater than that of women for a long time, which leads to more opportunities for men to induce lumbar disc herniation. Occupation: This disease is common and multi-infarct, widely present in all walks of life, with labor-intensive industries, in addition, a large proportion of people working in a sitting position for a long time also suffer from the disease. Environment: people who work or live in a wet and cold environment for a long time are more prone to lumbar disc herniation. According to statistics, a higher percentage of people who work underground in mines for years suffer from this disease. Other aspects: Is lumbar disc herniation related to genetic factors? There is no final conclusion yet, but it is certain that certain people with congenital dysplasia of the lumbar spine, such as those with scoliosis and congenital spina bifida, have a higher chance of concurrent lumbar disc herniation. In addition, such as pregnant women, due to special physiological reasons, resulting in a sudden increase in stool, coupled with relative muscle weakness and ligamentous laxity, is a dangerous period to induce this disease. Fourth, what is the relationship between posture and lumbar disc herniation? Usually those who need to stand and sit for a long time in their profession, such as nurses, counter girls, beauticians, teachers, office workers, computer operators or those who often need to bend over and lift heavy objects, such as movers, people who often need to carry goods, housewives, etc. or players and actors who need to do weight lifting, jumping, tumbling and so on; or pregnant women who are overloaded in the abdomen in late pregnancy. At the beginning, it may only be general lower back pain, or back pain, but if you do not pay attention to it for a long time, you can adjust your posture and do effective actions to relieve pressure on the lumbar discs, which may become lumbar disc herniation after a long period of accumulation. Clinical practice has proven that the lumbar disc pressure is highest in the sitting position, middle in the standing position and lowest in the lying position. The pressure of weight on the lumbar disc can be removed in the recumbent position. Through the lumbar disc pressure measurement found that if the spinal load in the standing position is calculated at 100%, the spinal load in the sitting position increases to 150%, while the standing forward flexion position is 210% and the sitting forward flexion reaches 270%. When standing and holding the weight of the lumbar segment of the spinal load increased significantly. This shows that sedentary, weight-bearing is a bad posture that leads to lumbar spinal degeneration and injury. Studies show that when sitting forward flexion, the pressure on the lumbar intervertebral disc is 2. 7 times higher than in standing forward flexion position. Therefore, the correct sitting posture is very important. Long-term sitting work, first of all, we should pay attention to the height of the table, chairs, to avoid sitting in a forward-flexed position, in addition will be accompanied by workers to change their posture often, regularly get up and move. In short, lumbar disc herniation is due to the lack of attention to some details of work and life, a moment to save, or think that the body is strong not to lose the correct scientific posture, resulting in the accumulation of injury to the lumbar spine. Therefore, it is cautioned that in order to protect the waist to pay attention to their every move. Fifth, what are the clinical manifestations of lumbar disc herniation? Lumbar disc herniation can show a variety of clinical symptoms according to age, gender, disease time and protrusion site, common clinical manifestations are as follows: A. Low back pain, more than 90% of patients have this performance. The pain is mainly in the lower back and lumbosacral region, with persistent dull pain most common, which can be reduced when lying down and increased when standing or sitting. The pain is mainly radiating stabbing pain. The radiating pain in the lower extremities may occur before or after the appearance of low back pain, both of which vary from person to person.C. Weak sensory and motor functions in the lower extremities, due to damage to the nerve roots, resulting in weakening or even loss of sensory and motor functions in their innervated areas. The common manifestations are skin numbness, coldness, decreased skin temperature, etc. In severe cases, muscle atrophy or even muscle paralysis can occur. d. Intermittent claudication, when patients walk, the symptoms of back and leg pain can be aggravated with the increase of walking distance, and can be relieved only after resting for a period of time in sitting or lying position. The reason is that the herniated nucleus pulposus induces this symptom secondary to lumbar spinal stenosis. e. Cauda equina symptoms, which manifest as numbness and tingling in the perineum, weakness in urination, and incontinence of bowel movement. Six, how can patients find out that they may have lumbar disc herniation? When patients experience a series of symptoms such as lumbago, lower limb numbness and pain after sudden flashback, sprain or lifting heavy objects, they should observe and check themselves from the following aspects to determine whether they are suffering from lumbar disc herniation. B. Whether the lumbar spine is bent to one side in an attempt to avoid pain, and whether the pain can be relieved to a certain extent after bending. c. Try to cough gently or several times to see if the symptoms of lumbar pain are aggravated. d. After resting in the supine position, if the pain is still not relieved, try to see if the pain is relieved when lying on the side, bending the waist, flexing the hips and knees. e. In the prone position, gently touch the middle of the lumbar spine at the back and Both sides, whether there is clear pressure pain. f. supine position, then sit up and observe whether the lower limb on the affected side can be flexed due to pain. g. supine position, the knee joint on the affected side is straightened and the affected limb is elevated, and observe whether its height is restricted due to pain. Several of the self-examinations described above can be performed by selecting a few items. If several of them match, the possibility of lumbar disc herniation should be suspected, but to really confirm the diagnosis, along must go to the hospital and ask the doctor for further examination to confirm. Seven, what are the treatments for lumbar disc herniation? There are usually three types of treatment methods: A. Conservative treatment: including methods such as Xiang massage and traction. B. Interventional treatment: Based on exhaustive research on the anatomy, biochemistry, biomechanics and imaging of the intervertebral disc, minimally invasive interventional treatment techniques have made rapid progress. Compared with traditional surgical methods, minimally invasive interventional techniques have the advantages of less trauma, faster recovery, no destruction of normal structures in the spinal canal and no impact on the biomechanical stability of the spine. For example, collagenase chemolysis, percutaneous laser disc decompression, plasma nucleus pulposus cryoablation, ozone ablation, and discoscopic intervention, etc. C. Surgery: 8%-10% of patients with disc herniation require surgery when non-surgical treatment is ineffective. In case of cauda equina injury or nerve palsy, emergency surgery should be performed to release the nerve compression as soon as possible. However, surgery is often more dangerous, more traumatic, affects the stability of the spine and is slow to recover after surgery.