Low back pain is a category of clinical symptoms that refers to pain in the lower back, lumbosacral, sacroiliac, and buttocks, sometimes accompanied by pain in one or both lower extremities and cauda equina symptoms. This symptom is quite common, almost all people have a history of low back and leg pain at least once in their lives, with varying signs and symptoms, often chronic, sometimes good and sometimes bad, affecting work and life. There is no significant difference in the incidence between men and women. There are many causes of lumbar leg pain, mainly acute and chronic injury to the soft tissues of the lumbar region, infection, lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis, rheumatoid arthritis, ankylosing spondylitis, lumbar spine congenital or developmental malformations, tumors, visceral diseases and so on. Among them, lumbar disc herniation, lumbar spinal stenosis and lumbar spondylolisthesis are the most common, and the following is a brief introduction to these three diseases. Lumbar disc herniation What is lumbar disc herniation? To understand lumbar disc herniation, you first need to understand what is the lumbar disc, intervertebral disc tissue is located between the two vertebrae is a connecting structure, is high in water containing plasma, elastic, its role in addition to making the spine similar to the joints of the role of the activities of the joints, but also cushioning the spinal column in the activities of the pressure generated by the vibration. Because the lumbosacral region has a high degree of mobility and more chances of injury, herniated discs mostly occur between the 4th and 5th lumbar vertebrae, or between the 5th lumbar vertebrae and the 1st sacral vertebrae. Generally after middle age, the intervertebral disc will gradually produce senile physiological degeneration with age. Due to long-term weight-bearing or incorrect posture and repeated cumulative injury can accelerate the degeneration of the intervertebral discs, when bending over to extract heavy objects, it can lead to degeneration of the intervertebral discs protruded into the spinal canal, compression, irritation of the nearby spinal nerve roots and produce symptoms of lumbar pain and leg pain, that is, lumbar disc herniation. What are the clinical symptoms of lumbar disc herniation? Herniated lumbar discs are more common in men between the ages of 20 and 40, and there are more male patients than female patients. Lumbar disc herniation clinical manifestations generally have two: one is lumbar pain, often sudden onset of lumbar pain, abnormally severe, some can also be manifested as gradually aggravated hidden pain, often confined to the lumbosacral region near the lower lumbar spine can be next to the pain point. Acute attack, the pain is intolerable, difficult to move, and even in bed can not turn over, supine legs can not be lifted up, bed rest after the symptoms can be gradually reduced or disappeared. The symptoms may gradually decrease or disappear after bed rest. Later on, the pain will recur and finally become chronic low back pain. The other one is radiating neuralgia of the lower limbs, i.e. sciatica, radiating pain in the sciatic nerve area of the lower limbs on the affected side, which is one of the typical symptoms of herniated disc. The pain usually starts from the buttocks, and gradually extends to the back of the thigh, the back of the calf, the ankle, the root of the foot or the sole of the foot. Standing, walking, coughing, sneezing and even straining to defecate can aggravate the pain, and bending the waist and straightening the leg to raise the sciatic nerve can aggravate the pain, or produce electric shock-like radiating pain. Normally, the waist tends to protrude to the side of the limb radiating pain, unconsciously forming a protective scoliosis. Bilateral sciatic nerve compression, can appear bilateral lower limb pain. In addition, at the same time can be accompanied by lower limb weakness and sensory loss, and may even have urinary and fecal disorders. If the patient has the above symptoms, especially young people, and ask about the history of weight-bearing, sprain history, you should go to the hospital for examination. Who is susceptible to lumbar disc herniation? Lumbar disc herniation is a degenerative disease of the lumbar spine that can occur in patients of any age, but it is more common in middle-aged people between the ages of 35 and 45, and is slightly more common in men than in women. One-third of patients have a history of trauma, and more than one-half of patients are manual laborers or have participated in long-term physical labor or sports. The following three occupations are high-risk factors for lumbar disc herniation. Heavy manual laborers, the incidence of which is highest in this group. Occupations that require long-term maintenance of a certain posture (especially bending forward, sitting and squatting), such as drivers and telephone operators. Occupations that require repeated repetitions of a fixed movement of the lumbar region. In addition, congenital or developmental deformities of the lumbar spine and a history of previous trauma to the lower back are also potential risk factors for lumbar disc herniation. It can be seen that lumbar disc herniation occurs not only in the crowd of heavy manual laborers, but also in the crowd of sedentary inactivity, middle-aged and elderly people, pregnant and pregnant women, etc. Therefore, it is very important to prevent the occurrence of this disease, which requires us to pay attention to the lumbar exercise in general. How to prevent lumbar disc herniation? The purpose of prevention is twofold: ① to prevent the occurrence, ② to prevent recurrence after treatment. Since this disease is mostly caused by age-related degeneration and chronic injury, the following principles and measures are necessary for prevention: ① Pay attention to the posture of standing, sitting, walking and labor. Classroom and office tables, chairs, height, industrial and mining labor conditions, labor intensity, as well as living and working habits, etc., must be noted and guidance. Forward bending action should be strictly controlled, in lifting or moving heavy objects can not bend, but should squat, and then stand up, to keep the waist straight, and avoid participating in the need to twist the waist of labor. ② Strengthen the waist and leg muscles exercise, often strengthen the back muscle strength and do to restore spinal mobility gentle exercise. After the disease or treatment with a stent can only play a temporary role, it is important to the outer stent “built into the body stent”, that is, to strengthen the lumbar muscle exercise, so that it has enough muscle strength to maintain spinal stability, long time to wear the outer stent against the lumbar muscle atrophy, can not rely on the lumbar muscle to achieve the purpose of stabilizing the spine to. Normally, workplace exercises play an important role in preventing occupational acute and chronic injuries. Preventing the aging of the body and tissues is a major medical issue, and the same applies to intervertebral disc degeneration. It is necessary to widely publicize the health care knowledge of intervertebral discs, regulate diet, enhance physical fitness and stabilize emotions. What tests are needed for lumbar disc herniation? Typical lumbar disc herniation can be initially diagnosed through medical history and clinical examination, but the diagnosis needs to be confirmed by x-ray, CT, MRI or myelography. In patients with suspected lumbar disc herniation, X-ray examination often suggests changes in the height of the intervertebral space, but cannot confirm the diagnosis. However, X-ray examination can suggest the presence of other bony lesions in the lumbar spine, such as fractures, tumors, and lumbar spondylolisthesis. CT and MRI are of great value to the diagnosis of lumbar disc herniation, which can show in detail the segment, type and degree of disc herniation, as well as the situation of nerve compression, which is of great reference value to the decision of whether or not to operate and the way of operation. How to treat lumbar disc herniation? There are many treatment methods for lumbar disc herniation, which can be categorized into two main types, non-surgical treatment and surgical treatment. Most of the patients can be relieved with non-surgical treatments, especially for the first time. Treatment must be combined with prevention in order to consolidate the effect of treatment and avoid recurrence. Different treatments are chosen according to the severity of the patient’s condition, the duration of the disease, the type of pathological changes, and the age of the patient. Patients with first-episode, mild disease generally choose non-surgical treatment, while patients who have failed to undergo non-surgical treatment, or who have severe, recurring disease, or who are accompanied by dysuria, need surgical treatment. The specific methods of non-surgical treatment include: complete bed rest, physiotherapy, magnetic therapy, drugs, traction, lumbar protection, epidural closure, nucleus pulposus chemolysis and so on. Lumbar disc herniation patients, in the acute stage, should be absolute bed rest, to sleep on a hard bed, which is to reduce the weight of the disc pressure, the waist also pad a small pillow, as little as possible to sit and less standing, after the symptoms are relieved to get up and move around, it is best to have a lumbar circumference protection. Deep lumbar physical therapy and massage can make the lumbar muscle spasm relaxation, further reduce the pressure of the intervertebral discs, massage due to the method of each person and the severity of different, not recommended. Medications are mainly non-steroidal anti-inflammatory drugs that have pain-relieving effects in addition to reducing the inflammatory reaction caused by nerve compression, and these drugs are more commonly used, such as Cilostro. Cilostro is the first cyclooxygenase 2-specific inhibitor of the criminal also approved by the U.S. FDA for the treatment of osteoarthritis and rheumatoid arthritis, acute pain, primary dysmenorrhea, and other antipyretic analgesic medications compared to the efficacy of the same, can significantly reduce gastrointestinal discomfort and gastric ulcers up to 8 times the rate of incidence of suitable for long-term use of the patient, do not have to worry about the adverse effects of the drug, the use of a more secure. Epidural hormone closure can inhibit the inflammatory reaction at the herniated disc site and nerve root, effectively relieve the pain in the acute stage, with relative safety, small side effects, easy to accept by the patient, etc. However, there are complications such as epidural hematoma, infection, and chemical meningitis, which requires absolute reliability of the injection technique, and the number of injections should not be too many, and the dosage should not be too large. Nucleus pulposus chemolysis is a minimally invasive treatment for herniated disc, which reduces the trauma caused by conventional surgery and injects enzymes capable of selectively degrading the nucleus pulposus of the intervertebral disc into the degenerated and herniated disc to catalyze the degradation of some of the components of the nucleus pulposus, reduce the pressure inside the nucleus pulposus, make the herniated disc revert to or narrow down the size, and reduce the compression on the nerve root, so as to achieve the purpose of eliminating or relieving the symptoms. Since 1994, our hospital has carried out collagenase chemolysis and treated more than 1,000 patients with lumbar disc herniation with positive results. Surgical treatment is divided into conventional surgery and minimally invasive surgery according to surgical methods, and minimally invasive surgery includes percutaneous puncture nucleus pulposus excision and suction, intervertebral discoscopic nucleus pulposus removal and microscopic nucleus pulposus removal, and so on. Recently, our hospital has carried out the international advanced level of artificial disc replacement surgery to treat lumbar disc herniation with promising results. Lumbar spinal stenosis What is lumbar spinal stenosis? Lumbar spinal stenosis is a common disease among degenerative spinal disorders, and its incidence increases significantly with age. The spinal canal is a bony channel that connects the vertebrae to the spinal cord and protects the spinal cord and nerve roots. However, if the lumen of the canal narrows and causes pressure on the nerve tissues, clinical symptoms and signs appear, which are called lumbar spinal stenosis. What are the clinical signs of lumbar spinal stenosis? The clinical manifestations of lumbar spinal stenosis include intermittent claudication, radiating pain in the thigh or calf after walking for a certain period of time, which is relieved by bending down and squatting, and then the pain can appear when walking again. Typical symptoms are pain in the lower limbs, but there are cases where the pain is confined to the lumbar area and the buttocks. Symptoms are aggravated by prolonged standing, activity or lumbar hyperextension, and relieved by sitting, lying down or lumbar flexion. In addition, patients often describe radiating burning, numbness, distension or weakness in the lower limbs. What tests are needed for lumbar spinal stenosis? Generally speaking, patients with suspected lumbar spinal stenosis can be initially diagnosed by history, clinical examination and plain film examination. X-ray examination often suggests multi-planar osteophytes, but osteophytes do not necessarily mean lumbar spinal stenosis, and X-ray examination may suggest spinal stenosis, including degenerative vertebral body slippage and degenerative lumbar scoliosis. CT has great value for the diagnosis of spinal stenosis, which can show detailed images of bone structure, especially the lateral socket area, intervertebral disc and ligamentum flavum can be distinguished from the dural sac, which is favorable for the diagnosis of extreme lateral disc herniation, and the latter may sometimes be combined with spinal stenosis at the same time. MRI is good for observing the soft tissue structure of the spinal canal, especially suitable for observing abnormalities of the intervertebral disc. Its diagnostic accuracy is better than that of myelography and unenhanced CT, and its sensitivity and accuracy are consistent with the results of myelography. MRI and CT are selectively used for patients who need surgical treatment to determine the surgical plan, to assess the plane of involvement, and for patients who need to exclude infection or tumor. They can provide an adequate assessment of the lumbar spine and often eliminate the need for preoperative myelography. How is lumbar spinal stenosis treated? Lumbar spinal stenosis can also be categorized into non-surgical and surgical treatments. Non-surgical treatments include medication, modification of activities, application of braces and epidural hormonal closure. Medications are mainly non-steroidal anti-inflammatory drugs that have pain-relieving effects in addition to reducing the inflammatory reaction caused by nerve compression, and these drugs are more commonly used, such as Cilostro and so on. It has been shown that intramuscular injection of calcitonin can reduce pain and increase the walking distance. The more effective physical therapy methods for treating lumbar spinal stenosis are tension therapy, lumbar muscle strength exercises and anaerobic health training. Riding a stationary bicycle is effective for some patients, and this exercise, with the low back in a flexed position, is tolerated by most patients. Walking exercises with a harness designed for pedaling are also useful for patients with lumbar spinal stenosis because the lumbar spine is not stressed. There are many methods used for soft tissue physical therapy, including: heat, ice, ultrasound, massage, electrical stimulation and traction. Exercise and physical therapy are safer and can delay surgical treatment. Exercise also improves the patient’s general condition, which facilitates better surgical treatment even if it doesn’t reduce symptoms.