Basic Overview
The American College of Physicians defines the nomenclature of lumbar disc lesions as follows.
I. Normal disc: no degeneration of the disc, all disc tissue is within the disc.
Second, disc bulging: (bulging) disc annulus fibrosus is uniformly beyond the intervertebral space, and the disc tissue does not protrude in a restricted manner.
Disc herniation: (protruded) limited displacement of disc tissue beyond the intervertebral space. The displaced disc tissue is still attached to the original disc tissue, and the diameter of its basal contiguous portion is larger than the displaced disc portion beyond the intervertebral space.
Disc extrusion: (extruded) Displaced disc tissue that is larger in diameter than the basal contiguous portion and displaced beyond the intervertebral space. The detached disc tissue mass is larger than the ruptured disc space and lies within the spinal canal through this fissure.
In China, lumbar disc herniation is also referred to as lumbar disc rupture, lumbar disc prolapse, lumbar intervertebral cartilage disc herniation, and lumbar cartilage plate rupture. Although the names and meanings of the above diseases differ, the current unified term is: lumbar disc herniation.
According to the clinical manifestations of the disease, it can be classified as “lumbago”, “lumbar and leg pain”, “paralysis” and other categories. Rather, the disease is classified under the category of “lumbago” and “lumbar and leg pain”.
Classification
The intervertebral disc is located between two adjacent vertebral bodies and is composed of two parts: the outer part is the fibrous ring, which consists of multiple layers of fibrocartilage rings arranged in a circular pattern around the nucleus pulposus, preventing the nucleus pulposus from protruding outward, and the inner part is the nucleus pulposus, which is an elastic gelatinous substance that has the effect of moderating impact. In adults, the intervertebral disc undergoes degenerative changes, the fibers in the annulus fibrosus become thicker, glass degeneration occurs and finally rupture, so that the disc loses its original elasticity and cannot bear the original pressure. Under overstrain, sudden change in position, violent action or violent impact, the annulus fibrosus can expand outward, so that the nucleus pulposus can also protrude outward through the fissure of the ruptured annulus fibrosus, which is called disc herniation.
Lumbar disc herniation can be divided into.
1, lumbar disc bulge: that is, the fibrous ring is not completely ruptured, the nucleus pulposus protrudes from the breakage to compress the nerve root;
2, lumbar disc herniation: rupture of the fibrous ring, the nucleus pulposus from the rupture, compression of the nerve root;
3, lumbar disc prolapse: the fibrous ring ruptures, the nucleus pulposus is extruded from the rupture and breaks through the posterior longitudinal ligament, freeing into the spinal canal and compressing the nerve root spinal cord.
Incidence of the population
(1) from the age: lumbar disc herniation occurs in young adults
(2) from the gender: lumbar disc herniation is mostly seen in men, the incidence rate of men is higher than that of women, and the ratio of men to women is generally considered to be ~:.
(3) from the body type: generally too obese or too thin people are prone to lumbar disc protrusion
(4) Occupationally: industrial workers with high labor intensity are more common, but the incidence rate of brain workers is not very low at present.
(5) from the posture: poor work posture row ambulatory workers and often standing salesman textile workers are more common
(6) from the living and working environment: often in the cold or humid environment have become a certain degree of induced lumbar disc herniation conditions
(7) In terms of different periods of women: prenatal and postnatal period and menopause are the risk periods for lumbar disc herniation in women
(8) People with congenital lumbar spine dysplasia or deformity, or even those who are too nervous, are prone to lumbar pain, and people who smoke may be related to the fact that coughing can cause an increase in the internal pressure of the intervertebral disc and the pressure in the spinal canal, making it easy for degenerative changes to occur.
Etiology
Degenerative changes of the lumbar intervertebral disc: degeneration of the nucleus pulposus is mainly manifested as a decrease in water content and can cause small-scale pathological changes such as destabilization and loosening of the pushed joints due to water loss; degeneration of the annulus fibrosus is mainly manifested as a decrease in the degree of toughness
The role of external forces: long-term repeated external forces cause minor damage to the lumbar intervertebral discs over time to aggravate the degree of degeneration
Weakness of the disc’s own anatomical factors: ① The disc gradually lacks blood circulation after adulthood and has a poor repair capacity. On the basis of the above factors, a trigger factor that can lead to a sudden increase in pressure on the disc may cause the less elastic nucleus pulposus to pass through the less tough fibrous ring, thus causing the nucleus pulposus to herniate.
Triggering factors for lumbar disc herniation may include.
①Sudden weight bearing or flashback is the main cause of rupture of the annulus fibrosus
② trauma to the lumbar region causing protrusion of the degenerated nucleus pulposus
③Inappropriate posture induces herniated nucleus pulposus
④Protrusion of the nucleus pulposus can also occur when the abdominal pressure is increased
⑤ cold and moisture cold or moisture can cause small blood vessel contraction muscle spasm to increase the pressure of the disc may also cause the degenerated disc to crack external factors for excessive weight bearing or rapid bending and lateral flexion and rotation to form a rupture of the annulus fibrosus or lumbar trauma improper posture in daily life and work can also occur lumbar disc herniation
After puberty, degenerative changes occur in various tissues of the human body, among which changes in the intervertebral disc occur earlier, the main change is the dehydration of the nucleus pulposus, after dehydration the disc loses its normal elasticity and tension, on this basis, due to heavy trauma or repeated inconspicuous injuries, resulting in weakness or rupture of the fibrous ring, the nucleus pulposus is protruded from the place.
The nucleus pulposus mostly protrudes into the spinal canal from the lateral posterior side (a few can be on both sides at the same time), compressing the nerve root and producing signs of nerve root injury; it can also protrude from the center to the posterior, compressing the cauda equina and causing urinary and fecal disorders. If the fibrous ring ruptures completely, the broken nucleus pulposus enters the spinal canal, causing extensive damage to the cauda equina. Since the lower back is heavily loaded and there are many activities, the protrusion mostly occurs in the lumbar 4-5 and lumbar 5-sacral 1 spaces.
Treatment measures
Herniated discs are caused by poor living and working habits. Poor sitting and standing posture as well as long-term bending or heavy physical labor are the causes of the disease. The herniated disc compresses the nerve and gives rise to symptoms of numbness, swelling, weakness of the limbs and pain. Removal of the herniated nerve compression is the root of treatment. The treatment plan used depends on the different pathological stages and clinical manifestations of this disease.
(a) Conservative treatment (including: medication, physical therapy, and dietary therapy)
1.Pharmacological treatment: taking anti-inflammatory and pain-relieving Chinese and Western drugs, and using external hot compress therapy, etc.
2, nerve block therapy: nerve block therapy is the injection of drugs into the nerve root, the spinal canal (sacral canal), etc., now commonly used: lateral interval block, sacral block, paravertebral block, cross block, lumbar major muscle sulcus block, etc., the drug is injected into the nerve root in different proportions, to eliminate edema and inflammation of the nerve root, for patients in the acute stage of severe pain, the pain relief effect is quite The pain relief effect is quite good for acute patients with severe pain. However, nerve block therapy should be operated by a professional doctor and carried out in a sterile treatment room with oxygen supply, monitor and other related equipment.
3 exercise: lumbar synostosis osteophytes these diseases are chronic diseases, do not believe in quick results! Do not believe in some exaggerated propaganda, this disease is not a one-time event, treatment should also follow the basic logic. Patients in the acute stage should be strictly bedridden for 3 weeks. After the pain is relieved, they should start exercising the lumbar back muscles, as well as hanging on the bar and swinging the leg back and forth exercises. It should be gradual, scientific and reasonable.
(II) Interventional treatment (including: radiofrequency ablation of disc herniation target, collagenase lysis, ozone injection, etc.)
Strictly speaking, interventional treatment should be a minimally invasive procedure, a treatment method between conservative treatment and surgical treatment, and sometimes requires comprehensive treatment. It should be performed under the guidance of imaging and other equipment.
Targeted radiofrequency ablation of herniated intervertebral discs is the use of high-energy local biological effects, namely burning, vaporization, denaturation and coagulation. Thus, it can reduce the internal pressure of the diseased disc, retract the protruding cervical and lumbar discs, release their compression on the spinal cord or nerve roots, restore their normal physiological functions, and eliminate the clinical symptoms of lumbar and leg pain, numbness and sensory and/or motor dysfunction caused by the patient’s protruding disc.
The principle of collagenase lysis: the nucleus pulposus of the human intervertebral disc is a substance composed of water, fibrous tissue and proteoglycans, and the full name of collagenase is collagenolytic enzyme, which dissolves the proteoglycans in the nucleus pulposus of the intervertebral disc to reduce or relieve the nerve compression by making the disc volume smaller.
Ozone injection, the effect of ozone is that high concentrations of O3 have a strong oxidizing power, as well as anti-inflammatory and analgesic effects. Injecting it into the nucleus pulposus of the herniated disc can instantly oxidize the proteoglycans in the nucleus pulposus and destroy the nucleus pulposus cells, so that the function of proteoglycans is lost, the cells produce less proteoglycans, and the osmotic pressure of the nucleus pulposus cannot be maintained, resulting in water loss and atrophy, thus reducing the pressure in the disc and eliminating the symptoms and achieving the purpose of treatment.
(iii) Surgical treatment, the indications for surgery are generally considered to be.
(①Non-surgical treatment is ineffective or relapses, and the symptoms are more severe and affect work and life.
(ii) Those with obvious and widespread symptoms of nerve damage, or even continued deterioration, with suspected complete rupture of the disc annulus fibrosus and protrusion of nucleus pulposus fragments into the spinal canal.
(③) Central type lumbar disc herniation with urinary and fecal dysfunction.
(iv) Combined with obvious lumbar spinal stenosis.
Precautions
Cervical and lumbar spondylosis is a chronic degenerative disease. Its clinical manifestations are diverse, and sometimes it is not easy to confirm the diagnosis. Once you have symptoms in this area, you must ask a specialist to help confirm the diagnosis, otherwise the diagnosis will be delayed and the treatment will be delayed. Once the diagnosis is clear, the following aspects should generally be noted.
1, to have a correct understanding of the disease, establish confidence in overcoming the disease: cervical and lumbar spondylosis is relatively long, pushing the degeneration of the intervertebral disc, the growth of bone spurs, ligament calcification and other related to ageing, the aging of the body. The disease is often recurrent, and the symptoms may be heavy during the attack, affecting daily life and rest. Therefore, on the one hand, we must eliminate the fear of pessimism, and on the other hand, we must prevent the mentality of getting by and giving up active treatment.
2, pay attention to rest: cervical and lumbar spondylosis acute attack or the first attack of the patient, pay proper attention to rest, the condition is more serious to bed rest 2-3 weeks. Bed rest has an important role in relaxing the neck muscles, reducing muscle spasm and the pressure of the head weight on the intervertebral discs, and the decompression of tissue pressure edema. However, bed rest should not be too long to avoid changes such as muscle atrophy, tissue adhesions and joint adhesions, which hinder the recovery of cervical and lumbar spondylosis. Therefore, during the interval and chronic period of cervical spondylosis, it should be appropriate to participate in work. Long-term rest is not required.
3, pay attention to maintenance: the human body is especially like a complex machine, from time to time need to be maintained. Especially cervical spondylosis, itself is a degenerative pathology, but also to protect the neck, try to avoid unnecessary injury. Whether it is sleep, rest. Or study and work, and even some daily movements, we must maintain good habits, and never forget the protection of the cervical spine. At the same time strengthen the exercise of the neck muscle.
4, the correct treatment: cervical and lumbar spondylosis treatment methods are conservative treatment and surgical treatment. Conservative treatment are: drugs, functional exercise, pain (or numbness, soreness) is significant, you can go to the pain clinic, find a professional doctor to do nerve block treatment, the vast majority of patients by conservative can relieve symptoms, and even cure does not occur. However, patients with ineffective conservative treatment and obvious nerve compression symptoms should consider surgery.