Lumbar intervertebral disc herniation I. Overview: Lumbar intervertebral disc herniation refers to the degenerative degeneration of the intervertebral disc, under the action of external forces, partial or complete rupture of the fibrous ring, the nucleus pulposus protrudes outward, stimulating or compressing the sinus nerve and nerve root caused by a disease with lumbar and leg pain as the main symptoms. Lumbar disc herniation is a common and frequent disease in orthopedics and is the most common cause of low back and leg pain. Second, the symptoms: 1, low back pain: the vast majority of patients with lumbar disc herniation have low back pain. Low back pain can appear before leg pain, or at the same time or after leg pain. However, the location of this type of pain sensation is deeper and inaccurately localized, generally dull pain, stabbing pain or radiating pain. There are two types of low back pain: one is widespread dull pain in the low back with a slow onset, aggravated by activity and prolonged single posture, and relieved by rest or bed rest, and the fibrous ring is still intact. The other type of low back pain has an acute and severe onset, with muscle spasm in the low back and restriction of various activities in the low back, generally lasting for a long time and relieved in 3-4 weeks. Sciatica: Since about 95% of disc herniation occurs in the lumbar 4, 5 and lumbar 5 sacral 1 intervertebral spaces, it is mostly accompanied by sciatica. Sciatica mostly occurs gradually, and the pain is mostly radioactive, from the buttocks, posterior and lateral thighs, lateral calves to the heel or dorsum of the foot. Sciatica is aggravated by activity or increased abdominal pressure. In the case of high disc herniation, the corresponding upper lumbar segment nerve root may be compressed and pain in the anterior medial thigh or groin may occur. Central lumbar disc herniation often compresses the cauda equina below the plane of herniation, manifesting as bilateral sciatica, perineal numbness, and urinary and defecation disorders. Female patients may have pseudo-incontinence, and male patients develop impotence. X-ray: X-ray radiographs of the lumbar spine can show scoliosis, straightening of the anterior lumbar arch, unequal or narrowing of the vertebral space and narrowing of the vertebral space, etc. In addition to being a reference for the diagnosis of lumbar disc herniation, X-ray radiographs can also exclude septic inflammation, tuberculosis and tumors of the lumbar spine, so they are indispensable in the diagnosis of lumbar disc herniation. 2, CT scan: CT scan examination is a non-invasive diagnostic means, and its confirmation rate is up to 90% or more. At present, CT scan has become the main examination method for the diagnosis of lumbar disc herniation. 3, MRI examination: MRI can directly show the degree of lumbar disc degeneration and the site and type of disc herniation as well as the dura and nerve root compression. Diagnosis: The diagnosis of lumbar disc herniation mainly relies on a comprehensive analysis of history, physical examination, X-ray examination, CT or MRI examination, etc. For a small number of patients with atypical symptoms and difficulties, some special examinations can be applied to assist in diagnosis and localization. V. Treatment: The treatment of lumbar herniated disc is divided into non-surgical treatment and surgical treatment, and the majority of lumbar herniated discs can disappear by non-surgical treatment. 1, non-surgical treatment methods: (1) bed rest Most patients with lumbar disc herniation can have their pain symptoms significantly relieved or gradually disappear by bed rest. Bed rest means that the patient needs to lie in bed all day, eating, washing and urinating and defecating in bed. (2) Traction therapy There are manual traction, gravity traction, mechanical traction, etc. Traction can be done in lying (supine or prone), sitting or standing position. (3) Tui-na massage Tui-na has good efficacy in the treatment of lumbar disc herniation. With the advantages of simple method, comfortable and effective, and few complications, it has been used as one of the comprehensive therapies for the treatment of lumbar disc herniation. However, it has been reported clinically that many patients had to undergo surgery because their symptoms worsened after massage. (4) Epidural steroid injection therapy Epidural steroid injection can reduce the symptoms, but it does not change the compression of the nerve root by the prolapsed nucleus pulposus, which itself has the risk of causing serious infection in the spinal canal and should be used with caution. (5) chemical lysis of the nucleus pulposus is rarely used because of the complexity of the operation, the efficacy is not as good as surgery, and there are more complications. 2, surgical treatment methods: most patients with lumbar disc herniation can achieve good results through non-surgical treatment, 20% to 30% of patients need surgery. (1) Indications for surgery ① Heavy symptoms, affecting life and work, invalidated by non-surgical treatment for 3-6 months, or severe symptoms, unable to accept non-surgical treatment such as traction and massage. ② Those who have extensive muscle paralysis, sensory loss and damage to the cauda equina nerve, and those who have complete or partial paralysis. ③ Those with severe intermittent claudication, if X-ray plain film and CT show spinal stenosis, and if it is consistent with clinical symptoms, early surgical treatment is appropriate. (3) Acute lumbar disc herniation with severe radicular pain that cannot be relieved and persistently aggravated. (2) Contraindications to surgery ① Lumbar disc herniation combined with important organ disorders and cannot tolerate surgery. (2) Those who have the first attack of lumbar disc herniation, whose symptoms are mild and can be relieved by non-surgical treatment, and whose impact on work and life is not obvious. (3) Those whose diagnosis of lumbar disc herniation is not clear and whose imaging does not show the characteristic manifestation of disc herniation. (3) Surgery: lumbar disc nucleus pulposus is a reliable and effective method for the treatment of lumbar disc herniation ① open nucleus pulposus surgery; ② hemilartebral laminectomy nucleus pulposus surgery: ③ total laminectomy nucleus pulposus surgery.