What is a herniated disc? The spine is made up of a series of interconnected bones, which are what we call vertebrae. The intervertebral disc is made up of strong connective tissue that sits between the vertebrae and effectively connects the upper and lower vertebrae. It acts as a rubber cushion, dispersing the force as it passes through the spine, cushioning it, and then transmitting it to the next vertebra. The periphery of the disc is very dense, called the “annulus fibrosus,” while the center is a gel-like tissue called the “nucleus pulposus. As a person ages, the nucleus pulposus begins to lose water, which causes the disc to become less elastic and less able to cushion pressure. The nucleus pulposus bursts through the fissure in the annulus fibrosus, which is a disc herniation. Most herniated discs occur in the 4th and 5th vertebrae of the lumbar spine, precisely because these are the last two discs in the body, where the forces on the spine are finally summed up. A herniated lumbar disc can compress the nerves emanating from the spine, resulting in pain, numbness, and weakness in the lower extremities, which is often referred to as “sciatica”. Sciatica occurs in 1 to 2 percent of the population, with most patients between the ages of 30 and 50. A herniated disc can also cause low back pain, but simple low back pain (no lower extremity pain, numbness, weakness) is more likely to be due to other causes. What are the treatments for a herniated disc in the lumbar spine? In acute attacks of lumbar disc herniation, 80-90% of patients can obtain relief through conservative treatment. However, if there are recurrent attacks of lumbar disc herniation or persistent lower extremity throbbing pain, surgery should be considered at this time. Surgical treatment has a success rate of over 90% for eliminating lower extremity throbbing pain, but provides limited relief of low back pain. Conservative treatment (non-surgical treatment) 1. Strict bed rest for two weeks should be preferred for acute attacks; 2. Oral anti-inflammatory drugs to reduce edema of nerve roots. Such anti-inflammatory drugs include NSAIDs and corticosteroids. Examples include aspirin, ibuprofen, dexamethasone, etc. It should be noted that anti-inflammatory drugs have varying degrees of side effects and should be used under the guidance of a doctor. 3.Take painkillers appropriately to reduce pain and relieve muscle tension. 4.Severe lower limb cramps can be treated with closure therapy. The purpose of this treatment is to reduce the swelling of nerves and intervertebral discs. Be sure to ask a doctor skilled in closure techniques to complete. 5. Physical therapy, including traction physiotherapy, can be considered. The following are some of the issues that must be clarified during the treatment of lumbar disc herniation: 1. Wearing a lumbar girth (or lumbar protector) can reduce the back pain during acute attacks to a certain extent, but it does not cure the disc herniation. 2, painkillers are useless for the fundamental treatment of herniated discs, and will not make you recover quickly. And long-term use of painkillers can bring serious side effects and dependence on drugs. 3, especially to correct the misunderstanding is that the anti-inflammatory drugs mentioned here is not antibiotics and other drugs. Because the herniated disc compression or stimulation of nerve roots and inflammation is a sterile inflammation, and not bacterial infection of the body caused by inflammation, so the application of antibiotics anti-inflammatory is not appropriate, but also ineffective. 4, massage can relieve non-specific back pain for a short time, but should be avoided in the vast majority of herniated discs. 5.Manipulation does not reset the herniated disc, but some patients with low back pain may have undergone manipulation and found the disease cured. This is because ① most patients with simple lumbar pain do not have lumbar disc herniation at all, but acute lumbar muscle strain (i.e. acute lumbar sprain), and the lumbar muscles are stuck near the small articular prominence, so the manual reset can release this stuck pressure with the help of muscle bouncing, thus relieving lumbar pain. ②The acute attack of disc herniation can be accompanied by small joint synapse disorder, and the same disorder is relieved by manipulation. Therefore, manual repositioning does not reset the intervertebral disc, nor does it release the compression of the disc on the nerve root. 6, imaging reports often appear in the word “disc bulge”, please note that “bulge” is not “protrusion”, bulge is within the normal physiological range, the bulging disc will not compress the nerve root. 7, accompanied by continuous lower limb pain, numbness of patients, after a month of regular conservative treatment, no improvement in symptoms, especially lower limb symptoms do not improve should be considered early surgery. To explain with an image metaphor, a herniated disc compressing the nerve root is like a stone on the grass, and conservative treatment is like fertilizing under the grass root. If the stone is small, the growth of the grass will not be affected by the fertilizer application. However, if the stone is very large, it is difficult to make the grass grow healthily even if it is watered and fertilized, then the stone must be removed, which is surgery. Surgical treatment The purpose of surgery is to relieve the pressure and irritation of the nerve root by the disc. There are two common surgical procedures: total discectomy and partial discectomy. Partial discectomy (nucleus pulposus removal) removes only the herniated part of the disc and the nucleus pulposus, so there is a certain recurrence rate, especially in young people under 30 years old, and the chance of recurrence of disc herniation after surgery sometimes reaches 40%, because young people are more active in social life, and the residual part of the disc can be herniated again with the accumulation of daily activities. Total discotomy often requires additional spinal fusion techniques to rebuild the stability of the spine, which is accomplished with the help of internal fixation with a nail bar, placement of an intervertebral fusion or bone graft.