The intervertebral disc consists of a cartilage plate, a nucleus pulposus, and a fibrous ring. The nucleus pulposus is surrounded by a fibrous ring, which is sandwiched by the cartilage plate above and below, forming a sandwich-like structure between the upper and lower vertebral bodies. Lumbar disc herniation is a series of symptoms and signs caused by the rupture of the fibrous ring of the intervertebral disc and the protrusion of the nucleus pulposus tissue, which compresses and irritates the nerve roots. Lumbar disc herniation is the most common disease causing low back pain. The factors that constitute lumbar disc herniation are disc degeneration, but they are also related to excessive lumbar loading, long-term vibration, spinal deformity, acute injury, etc. Clinical symptoms 1. Low back pain The vast majority of patients with lumbar disc herniation have low back pain. Low back pain can occur before, at the same time or after leg pain. It is usually dull, stabbing or radiating pain. 2.Sciatica Sciatica mostly occurs gradually, and the pain is mostly radiating, from the buttocks, posterior and lateral thighs, lateral calves to the heel or dorsum of the foot. 3. Physical signs: change in spinal posture, pressure points in the low back, positive straight leg raise test, etc. Treatment principles The treatment of lumbar disc herniation is divided into non-surgical treatment and surgical treatment. 1.Non-surgical treatment The main purpose of non-surgical treatment is to make the inflammatory edema of the herniated part of the intervertebral disc and the stimulated nerve root subside faster, so as to reduce or release the compression of the nerve root and make the pain reduce or subside. (1) Bed rest This is the simplest treatment method. The use of semi-elevated upper body position, or hip flexion and knee flexion side position, can obviously release the pressure on the intervertebral disc and nerve roots. Bed rest makes the affected area still and also helps the inflammation to subside. If the treatment is adhered to, the patient can expect to be relieved within 3-4 weeks if he/she is in a hard bed. (2) Traction Traction includes pelvic traction, vertical suspension traction and mechanical traction. Traction increases the vertebral space, pulls the synovial joints apart and tenses the posterior longitudinal ligaments, which helps to partially reset the herniated nucleus pulposus. It can also significantly relieve the pressure on the intervertebral space and nerve roots, thus relieving the symptoms. (3) Tui-na, massage and physiotherapy Tui-na, massage and physiotherapy can relieve muscle spasm and reduce pressure in the intervertebral disc. Tui-na and massage can change the relative relationship between the herniated nucleus pulposus and the nerve root and reduce the pressure on the nerve root, but if used improperly, they can also aggravate the herniation and make the symptoms worse. (4) Drug treatment Non-hormonal anti-inflammatory painkillers can help to relieve pain and eliminate inflammation. Appropriate application of diuretics can also reduce edema and congestion of nerve roots. (5) Application of epidural hormones Epidural injection of long-acting hormones and anesthetic drugs (lidocaine, bupivacaine or procaine) is a good treatment for lumbar discogenic lumbar pain, with 60-85% of recent effects and 30-40% of long-term effects. The vast majority of patients with lumbar disc herniation have their symptoms relieved or disappeared after non-surgical treatment, however, about 10% of patients still need surgical treatment. (2) Before deciding on surgical treatment, both the operator and the patient should understand that surgery can only eliminate the symptoms but not cure the disc lesion and restore it to normal; (3) The spine should still be protected after surgery, and repeated bending and rotational activities should not be performed, especially heavy lifting in the flexed position of the spine should be avoided as much as possible. Case: microdiscectomy assisted by METRx system Male, 36 years old, with sudden onset of severe lumbar and leg pain for one month, MRI showed a herniated disc at L5-S1.