What are the common symptoms of lumbar disc herniation? Patients with lumbar disc herniation can exhibit a variety of clinical symptoms depending on the location, size, duration of disease and individual differences of the herniated nucleus pulposus. The main clinical manifestations are: 1. lumbar pain: most patients with lumbar disc herniation have this symptom. Low back pain can occur after a definite sprain or trauma, or it can occur without an obvious cause. Low back pain is widespread, but mainly in the lower back and lumbosacral region, with a dull pain that is sometimes mild and sometimes severe, and a sharp tearing pain in the acute stage, which is relieved when lying down and increased when standing for a long time or bending over. The mechanism of pain is that the metabolites produced by the rupture of the herniated fibrous ring of the nucleus pulposus stimulate the nerve fibers of the surrounding tissue. When the pain is severe, the lumbar spine activity can be significantly restricted. 2. One-sided or bilateral lower limb radiating pain: lower limb radiating pain may appear before the occurrence of lumbar pain, or after or at the same time as lumbar pain. The pain is mainly along the hip, thigh and the back of the calf to the root of the foot or the back of the foot, with radiating stabbing pain, and in severe cases, it can be electric shock-like pain. In order to reduce the pain, the patient often adopts a protective posture of flexion of the waist, hip, knee, and scoliosis. Radiation pain usually occurs on one side of the lower extremity, i.e. the side of the herniated nucleus pulposus. A small number of patients with central herniation may have bilateral lower extremity radiating pain, generally one side is light and one side is heavy. The direct cause of lower extremity radiating pain is the stimulation of the nerve root by the protrusion and its inflammatory metabolites. 3. Lower extremity numbness and sensory abnormalities: The onset of lower extremity numbness usually occurs after or in conjunction with pain relief, and the mechanism is mainly the mechanical compression of the proprioceptive and tactile fibers of the nerve roots by the protrusions. The area of numbness or hyperalgesia corresponds to the involved nerve root. The sensory abnormalities in the lower extremities are mainly chills and a decrease in the temperature of the affected extremity, especially at the end of the toes, which is most obvious due to the stimulation of sympathetic nerve fibers in the paravertebral area, causing vasoconstriction in the lower extremities. 4, muscle weakness or paralysis: protruding intervertebral disc compression of nerve roots in severe cases, can produce nerve paralysis and weakened muscle strength or even paralysis. This is mostly due to the herniated lumbar 4-5 intervertebral disc, lumbar 5 nerve root compression paralysis. Generally, the anterior tibial muscle, peroneal long and short muscles, extensor digitorum longus, extensor digitorum longus muscle paralysis can occur, manifesting as decreased thumb extension force or flexion force, or in severe cases, foot drop. 5, intermittent claudication: when the patient walks, the symptoms of lumbar leg pain can be aggravated with the increase of walking distance, and after a period of rest, he can walk again, and then walk the same distance again with the same symptoms. This is due to the lumbar disc herniation secondary to lumbar spinal stenosis, which after walking can prompt physiological congestion of blood vessels in the nerve roots of the corresponding spinal ganglion in the spinal canal, followed by venous stasis and the appearance of radiculitis, aggravating the symptoms. 6, cauda equina symptoms: central type of lumbar disc herniation, if the herniation is large, or bony stenosis of the spinal canal, can compress the cauda equina nerve, numbness and tingling of the perineum, weakness of urination and defecation; women can appear incontinence, men can appear impotence. This type should be treated with surgery as soon as possible. 7. Signs: reduced physiological anterior convexity, flattening or posterior protrusion of the lumbar spine: under normal circumstances, the spine has four bumps from the lateral view, namely, anterior convexity of the cervical spine, posterior convexity of the thoracic spine, anterior convexity of the lumbar spine and posterior convexity of the sacral spine. As the herniated disc stimulates the corresponding nerve roots and causes pain, in order to make the tension of the herniation smaller to reduce the stimulation of the nerves, the posterior part of the vertebral space is widened, thus the physiological anterior convexity becomes smaller in appearance, or even flat or posterior convexity, in order to widen the posterior space as much as possible, so that the tension of the posterior longitudinal ligament increases and the nucleus pulposus is partially returned. At the same time, the ligamentum flavum can be tensed accordingly, increasing the volume of the spinal canal. The main signs are as follows: (1) Lumbar scoliosis: Lumbar scoliosis can be convex to the affected side or to the healthy side, depending on the relationship between the protrusion and the nerve root. If the protrusion is on the medial side of the nerve root, the lumbar spine is laterally curved to the healthy side, thus reducing the compression of the protrusion on the nerve root; on the contrary, if the protrusion is on the lateral side of the nerve root, the lumbar spine is laterally curved to the affected side. Some patients show alternating lateral bending changes, which is often due to the herniation being located directly in front of the nerve root, which can move medially or laterally to the herniation when the lumbar region is active. This sign indicates that the nerve root is not adherent to the prominence. Generally speaking, lumbar 4-5 disc herniation appears to be more pronounced in lumbar scoliosis than lumbar 5 and sacral 1. (2) Pressure pain points: pressure pain points next to the lumbar spine are of great value in the diagnosis of lumbar disc herniation. The pressure pain points are mostly located next to the spinous process of the lesion gap. If the herniation occurs in the lumbar 4-5 space, there is deep pressure pain next to the lumbar 4-5 spinous process. Typically, the pressure pain may radiate to the ipsilateral buttocks and lower limbs. This is because the deep pressure stimulates the dorsal root nerve fibers of the lumbar back muscles, causing the nerve roots, which were already hypersensitive, to produce sensory pain. The degree of radiation varies, with some patients only radiating to the sacrococcygeal region or ipsilateral buttocks, and some patients have no obvious radiating pain, and even pressure pain is not obvious. This is related to the accuracy of the site of pressure pain, the degree of development of the patient’s muscles, and the different stages of lesion development. (3) Restricted lumbar activities: Under normal circumstances, the lumbar spine flexes about 45 degrees anteriorly, extends 20 degrees posteriorly, and flexes 30 degrees laterally to the left and right respectively. In the case of lumbar disc herniation, anterior flexion, posterior extension and lateral flexion of the lumbar region are restricted.