Overview This disease refers to a series of symptoms caused by the herniated nucleus pulposus of the lumbar intervertebral disc compressing the surrounding nerve tissue. The main change is the dehydration of the nucleus pulposus. After dehydration, the disc loses its normal elasticity and tension, and on this basis, due to heavy trauma or repeated inconspicuous injuries, the fibrous ring becomes weak or ruptures, and the nucleus pulposus protrudes from there, compressing the nerve root and producing signs of nerve root injury. The nucleus pulposus will protrude from the nerve root and compress the nerve root to produce signs of nerve root injury. If the fibrous ring ruptures completely, the broken nucleus pulposus enters the spinal canal, causing extensive damage to the cauda equina. Because of the heavy load and activities in the lower back, the protrusion mostly occurs in the lumbar 4-5 and lumbar 5-sacral 1 spaces. Shanghai Changhai Hospital Spine Surgery Department Li Ming symptoms (a) low back pain and radiating pain of one lower limb are the main symptoms of the disease. Low back pain often occurs before leg pain, or both can occur at the same time; most have a history of trauma, or there may be no clear cause. The pain has the following characteristics: 1. The radiating pain is transmitted along the sciatic nerve and reaches the lateral calf, dorsum of the foot or toes. In case of lumbar 3-4 interval herniation, radiating pain to the front of the thigh is caused by the compression of the lumbar 4 nerve root. 2. All actions that increase the pressure of cerebrospinal fluid, such as coughing, sneezing and defecation, can aggravate the lumbar pain and radiating pain. 3. Pain increases with activity and decreases after rest. Bed position: Most patients are in lateral recumbency with flexion of the affected limbs; individual severe cases have pain in all positions and can only bend their hips and knees in bed to relieve symptoms. In combination with lumbar spinal stenosis, there is often intermittent claudication. (B) Scoliosis deformity: the main bend in the lower back, more obvious when forward flexion. The direction of scoliosis depends on the relationship between the herniated nucleus pulposus and the nerve root: if the herniation is located in front of the nerve root, the trunk is usually bent to the affected side. (iii) Restriction of spinal movement: the herniated nucleus pulposus compresses the nerve roots, causing protective tension in the lumbar muscles, which can occur unilaterally or bilaterally. Due to the tension of the lumbar muscles, the physiological anterior convexity of the lumbar spine disappears. The anterior flexion and posterior extension of the spine is restricted, and radiating pain to one lower limb may occur during anterior flexion or posterior extension. (iv) Lumbar pressure pain with radiating pain: There is a limited pressure pain point next to the spinous process on the affected side of the disc herniation site, and it is accompanied by radiating pain to the calf or foot. In most patients with lumbar disc herniation, the correct diagnosis can be made based on clinical symptoms or signs. x-ray films should be taken of the lumbosacral spine in frontal and lateral position, with additional left and right oblique films if necessary. x-ray signs cannot be used as a basis for confirming the diagnosis of lumbar disc herniation, but they can be used to exclude some disorders. When there is difficulty in diagnosis, special examinations such as spinal iodine oil imaging, CT scan and MRI can be considered to clarify the diagnosis and the site of herniation. Patients with no obvious abnormalities in the above tests are not completely excluded from lumbar disc herniation. Treatment (a) Non-surgical treatment. Rest on a hard bed, supplemented by physical therapy and massage, can often be relieved or cured. Prone traction is easy to reset by shaking, the cure rate is high, easy for patients to accept, and is a commonly used non-surgical treatment. (ii) Surgical treatment. The indications for surgery are: (1) non-surgical treatment is ineffective or relapse, and the symptoms are heavy and affect work and life. (2) Nerve damage symptoms are obvious and extensive, and even continue to deteriorate, with suspected complete rupture of the disc annulus fibrosus and protrusion of the nucleus pulposus fragment into the spinal canal. â‘¢Those with central type lumbar disc herniation with urinary and fecal dysfunction. (iv) Those with combined obvious lumbar spinal stenosis. Heavy physical work should be avoided for six months after surgery.