【Overview】 Lumbar disc herniation is one of the common causes of back and leg pain, the disease is mostly seen in strong male manual laborers, most often workers, easy to occur between 20-40 years old, the onset of the site between the lumbar 4, 5 most, lumbar 5 sacral 1 next, lumbar 3-4 less common. The composition of the lumbar intervertebral disc: 1, cartilage plate. 2, nucleus pulposus. 3, fibrous ring. The intervertebral disc is a confined structure with hydrodynamic characteristics. Due to the flow of gelatinous fluid within the elastic container, it can cause rocking chair-like motion of the disc. The intervertebral disc contains 80% water, which has variability and can resist various pressures between vertebral bodies, maintaining the separation between vertebral bodies and absorbing a large amount of vibratory force to protect the function of the central nervous system. The intervertebral discs, the small joints behind the vertebral bodies and the various groups of ligaments, which closely connect the spine, give the spine good flexibility and stability. Zheng Lin, Department of Traditional Chinese Medicine and Orthopedics, Gucheng County People’s Hospital With the growth of age, and the continuous exposure to external forces such as extrusion, pulling and twisting, the intervertebral disc gradually degenerates and degenerates, the water content of the nucleus pulposus gradually decreases and loses elasticity, followed by narrowing of the vertebral space, relaxation of the surrounding ligaments, or fissures, forming the endogenous cause of lumbar disc herniation. When suddenly subjected to external forces, such as rotational movements under bending and weight-bearing, the external fibers of the annulus fibrosus are subjected to excessive tension and fracture, causing the disc to protrude posteriorly or laterally; or the lumbar muscles spasm due to cold in the lumbar region, prompting the disc with degenerative changes to protrude. The herniated disc can stimulate or compress the nerve roots and spinal cord, causing edema, congestion, degeneration, and adhesion to the surrounding tissues over time, resulting in nerve root irritation and loss of function. Diagnostic points】 1. History of chronic injury to the lumbar region. 2.Lumbar pain with sciatica. 3. Lateral convexity deformity of the lumbar spine, loss of physiological anterior convexity, limitation of movement, and pressure pain next to the spinous process and radiating to the lower limbs. 4. Positive straight leg raise test and strengthening test. The flexion neck test, jugular vein compression test, and femoral nerve pull test were positive. 5.Neurological examination shows abnormal knee and Achilles tendon reflexes and hypersensitivity or dullness of sensation in the skin nerve segment distribution area of the lower limbs. 6.X-ray film shows narrowing of the vertebral space, hyperplasia of the vertebral margin, loss of scoliosis and anterior convexity of the spine, and other diseases are excluded. Myelogram shows indentation defects in front of the dura. 7. CT scan and MRI suggest disc herniation. Differential diagnosis】 I. Lumbar nodal tuberculosis Lumbar pain may be accompanied by sciatica, often with systemic symptoms, persistent, with increased hematocrit, with cold abscesses palpable in the lower lumbar region, and x-ray showing blurring and narrowing of the intervertebral space and bone destruction at the relative edges of the vertebral body. Second, lumbar spinal stenosis The sciatic nerve involvement exhibited by this disease is not obvious, the sensory loss is not obvious, the muscle weakness is not much, and the distribution of nerve regions is not typical, all of which are not as clear as in patients with disc herniation. Vertebrogram or myelogram can be helpful, and CT and MRI are the best means of differentiation. Cauda equina neuroma is more common than neurofibroma. The symptoms are persistent without intermittent relief, and the pain is aggravated when lying in bed and cannot sleep at night. In severe cases, the tumor can compress the cauda equina nerve and cause sensory and motor disorders of lower limbs and sphincter dysfunction. The total protein amount of cerebrospinal fluid is increased. Myelogram has occupying lesions. Low back pain with sciatica, mostly in lumbar 5. The former shows fissures and bone defects in the isthmus of the vertebral arch on oblique radiographs. In spondylolisthesis, there is an increase in lumbar lordosis and a step-like presentation of the spinous process. x-ray shows a fissure in the arch and an anterior displacement of the lumbar 5 vertebrae. V. Ankylosing spondylitis The lesions are progressive, with early lumbar pain with sciatica. X-rays show an increase in the sacroiliac joint gap in the early stages, blurring of the joint gap in the middle stages, and loss of the gap in the later stages. Sixth, intervertebral discitis occurs mostly in children, rare in adults or with a history of surgery. Radiographs show narrowing of the intervertebral space, later widening of the relative edges of the two vertebral bodies, and finally fusion between the vertebral bodies. VII. Pear-shaped muscle syndrome This disease is mainly due to the spasm, congestion and edema of the muscle caused by the injury of the pear-shaped muscle to compress the sciatic nerve, or caused by the anatomical variation of the sciatic nerve. However, the patient has no low back pain or positive signs in the low back. There is significant localized pressure or radiating pain mainly in the pear-shaped muscle, and swelling and spasm of this muscle can be palpated. After local closure, the symptoms and signs are immediately reduced and alleviated or disappeared. Diagnostic hints] Based on the history, symptoms and signs, and x-ray films, a correct diagnosis and lesion localization can be made for most disc herniations. Some people summarize the main clinical symptoms and signs of this disease into one sentence, namely “back pain plus leg pain, pressure pain radiating pain”. This can be used as a reference for diagnosis. The choice of treatment depends on the different pathological stages and clinical manifestations of the disease, as well as the physical and psychological conditions of the patient. The majority of lumbar disc herniation can be relieved and cured by non-surgical treatment. Most patients with lumbar disc herniation can have their pain symptoms relieved significantly or gradually disappear through bed rest. The pressure of weight on the disc can be taken out in the recumbent position, and braking can release the muscle contraction force and the intervertebral ligament tension force on the disc; facilitate the nutrition of the disc; accelerate the venous return; take out edema; and promote the inflammation to subside. Therefore, bed rest is the basis of non-surgical treatment. Generally, it is necessary to lie flat on a hard bed for 2-3 weeks, and after the symptoms are relieved, wear a peri-waist to protect the activities on the ground and try to avoid bending. (2) Traction therapy Traction can reduce the pressure of the intervertebral disc, promote the nucleus pulposus to different degrees of retraction; promote the inflammation to subside; release the muscle spasm and the posterior lumbar joint load, so as to achieve the purpose of treatment. (iii) Tui-na therapy Tui-na manipulation can make the herniated nucleus pulposus partially returned; release muscle spasm, adjust the position relationship between lumbar intervertebral disc and nerve roots, release nerve root adhesions, and restore the normal anatomical sequence of lumbar vertebrae, so as to achieve the treatment purpose. (iv) Acupuncture therapy Acupuncture has the effects of central analgesia and adjustment of plant nerve function and neurotransmitters and body fluids. (E) Closure therapy Closure has the effects of analgesia, anti-inflammation and protection of the nervous system. However, it is contraindicated for active tuberculosis, acute systemic infection, tissue infection at the site of closure, diabetes mellitus, extreme physical weakness, and severe hepatic and renal insufficiency. Limited surgery for lumbar disc herniation Limited surgery for lumbar disc herniation is to reduce the trauma caused by conventional surgical methods, and to focus on the degenerated and herniated nucleus pulposus without involving the fibrous ring and cartilage end plate by using drugs, mechanical removal and laser, in order to reduce the pressure on the nerve root and make the symptoms of the disc disappear and be cured. Limited surgery is also known as minimally invasive surgery and is not described in this article because of the numerous surgical methods available. Indications: 1. A long history of disease, more than 3 months, who has been ineffective by systematic conservative treatment. 2.Those who have a short medical history but are in heavy pain, seriously affecting their daily work and life, and require surgical treatment. 3.Imaging examination confirms a mild to moderate limited protrusion or bulge of the intervertebral disc, or although there is osteophyte or joint hyperplasia at the posterior edge of the vertebral body, the protrusion or bulge of the intervertebral disc is the main compression factor, and it is consistent with the clinical manifestations. Relative contraindications and contraindications: 1, disc nucleus pulposus prolapse or free. 2. Calcification of the intervertebral disc annulus fibrosus. 3, the lumbar spine has significant instability. 4, Although imaging shows a herniated disc, the symptoms are mainly low back pain without radicular radiating pain of the lower extremities. 5.Severe degenerative lesions of the lumbar spine, such as severe narrowing of the intervertebral space, narrowing of the lateral saphenous fossa, osteophytes and hypertrophy and ossification of the ligamentum flavum, constitute the main factors of nerve root and dural sac compression. 6, combined with cauda equina damage. 7.Severe loss of muscle strength and foot drop. 8.The presence of significant social and psychological factors. Surgical treatment (a) Indications for surgery 1. History of lumbar disc herniation for more than six months, after conservative treatment is ineffective. The duration of conservative treatment should be at least 6 weeks but not more than 3 months. The criterion for failure of conservative treatment is not only that the pain is not relieved and the positive straight leg raising test does not improve or the neurological symptoms continue to worsen. 2. The first violent attack of lumbar disc herniation, especially the lower extremity symptoms are obvious, the patient has difficulty to move and sleep due to pain, and is forced to be in the lateral position with hip and knee flexed, or even kneeling. 3. Single nerve palsy or cauda equina palsy occurs, manifesting as muscle paralysis or the appearance of rectal and bladder symptoms. 4.Patients of middle age with a long history of disease, which affects work or life. 5.The medical history, although atypical, is shown by myelogram, epidurography, vertebral arteriogram, CT, MRI showing total degeneration or larger protrusion. 6.It is effective for conservative treatment, but the symptoms are recurrent and the pain is heavy. According to statistics, 90% of patients can relieve symptoms after the first attack. However, when the second attack occurs, although 90% of the patients’ symptoms can still be relieved, 50% of them will have another attack, and surgery should be considered at this time. When the third attack, although the symptoms can be relieved, but almost all patients will continue to recur, then surgery should be recommended. 7. The herniated disc has other causes of lumbar spinal stenosis. (B) Contraindications to surgery 1. Lumbar disc herniation affecting work and study is not obvious. 2, lumbar disc herniation for the first time or multiple episodes, without conservative treatment. 3.Lumbar disc herniation with extensive fibrillitis, rheumatism, etc. 4.Clinical suspicion of lumbar disc herniation, but no special signs are seen on special X-ray examination. The choice of treatment method depends on the different pathological stages and clinical manifestations of the disease, as well as the physical and psychological conditions of the patient. The majority of lumbar disc herniation can be relieved or cured by non-surgical treatment. In other words non-operative therapy is the basic treatment for this disease.