For drivers who sit in the office for a long time and often drive, there is a very troubling disease, lumbar disc herniation, this disease pain is very deadly, patients know it well. So do you know whether there is a hidden danger of disease in your own body? Do you understand some clinical manifestations of lumbar disc herniation? Clinical symptoms 1. Low back pain is the first symptom that appears in most patients, with an incidence of about 91%. As the outer layer of the fibrous ring and the posterior longitudinal ligament are stimulated by the nucleus pulposus, the induction pain in the lower back is produced by the sinus vertebral nerve, and sometimes it can be accompanied by pain in the hip. 2. Lower limb radiating pain Although high lumbar disc herniation (lumbar 2 to 3, lumbar 3 to 4) can cause femoral neuralgia, it is rare clinically, less than 5%. The vast majority of patients are herniated from lumbar 4 to 5 and lumbar 5 to sacral 1 gap, which manifests as sciatica. Typical sciatica is radiating pain from the lower lumbar region to the buttocks, posterior thighs, and lateral calves up to the feet, and the pain increases in response to increased abdominal pressure such as sneezing and coughing. The radiating pain is mostly on one side of the limb, and only a very few people with central or paracentral medullary herniation show symptoms in both lower limbs. There are three causes of sciatica: (1) chemical inflammation of the nerve root due to chemical stimulation and autoimmune reaction from the ruptured disc; (2) compression or traction of the herniated nucleus pulposus on the already inflamed nerve root, blocking its venous return and further aggravating edema, making it more sensitive to pain; (3) ischemia of the compressed nerve root. The above three factors are interrelated and aggravating factors. 3. Cauda equina symptoms The protruding nucleus pulposus or prolapsed, free disc tissue compresses the cauda equina nerve, which mainly manifests as obstruction of bowel movement and urination, and abnormal perineal and perianal sensation. In severe cases, symptoms such as loss of control of urination and defecation and incomplete paralysis of both lower extremities may occur, which are rare in clinical practice. Signs of lumbar disc herniation 1. General signs (1) Lumbar lordosis: It is a postural compensatory deformity to reduce pain. Depending on the relationship between the site of the herniated nucleus pulposus and the nerve root, the spine is bent to the healthy side or to the affected side. If the site of the herniated nucleus pulposus is located on the medial side of the spinal nerve root, the lumbar spine bends to the affected side because the spine bends to the affected side to reduce the tension of the spinal nerve root; conversely, if the herniated nucleus pulposus is located on the lateral side of the spinal nerve root, the lumbar spine bends to the healthy side. (2) Restriction of lumbar movement: Most patients have varying degrees of restriction of lumbar movement, which is especially obvious in the acute stage, with the most obvious restriction in forward flexion, because the nucleus pulposus can be further displaced backward in forward flexion and increase the pull on the compressed nerve roots. (3) Pressure pain: percussion pain and sacral spasm The site of pressure pain and percussion pain basically corresponds to the vertebral space of the lesion, and is positive in 80% to 90% of cases. The percussion pain is obvious at the spinous process, which is caused by percussion vibration of the lesion. The pressure point is mainly located at 1 cm of the paravertebral area, and radiating pain along the sciatic nerve may occur. About 1/3 of patients have lumbar sacral spasm. 2. Special signs (1) Straight leg raising test and strengthening test: the patient lies supine, extends the knee and passively raises the affected limb. In normal people, the nerve root has 4mm sliding degree, and the lower limb is elevated to 60°~70° before feeling discomfort in the N fossa. In patients with lumbar disc herniation, the nerve root compression or adhesion reduces or disappears the sliding degree, and sciatica can occur within 60° of elevation, which is called a positive straight leg elevation test. In positive patients, slowly lowering the height of the affected limb and waiting for the radiating pain to disappear, then passively flexing the affected ankle joint to induce radiating pain again is called a positive strengthening test. Sometimes, because of the large nucleus pulposus, elevation of the healthy lower limb can also pull the dura mater to induce radiating pain in the sciatic nerve on the affected side. (2) Femoral nerve pull test: The patient is placed in a prone position with the knee joint of the affected limb fully extended. The examiner elevates the straightened lower limb so that the hip joint is in the hyperextended position, and when the hyperextension reaches a certain level and pain occurs in the femoral nerve distribution area in front of the thigh, the test is positive. This test is mainly used to examine patients with lumbar 2 to 3 and lumbar 3 to 4 disc herniation. 3, neurological manifestations (1) sensory disorders: depending on the location of the affected spinal nerve roots, abnormal sensation in the innervated area of the nerve may occur. The positivity rate is more than 80%. In the early stage, the symptoms are mostly skin sensation, and gradually numbness, tingling and hyperalgesia appear. Because the affected nerve roots are mostly single-jointed and unilateral, the scope of sensory impairment is small; however, if the cauda equina is involved (central type and paracentral type), the scope of sensory impairment is more extensive. (2) Decreased muscle strength: 70% to 75% of the patients showed decreased muscle strength. In case of lumbar 5 nerve root involvement, ankle and toe dorsiflexion strength decreased, and in case of sacral 1 nerve root involvement, toe and foot plantarflexion strength decreased. (3) Reflex changes: It is also one of the typical signs that are prone to occur in this disease. When the lumbar 4 nerve root is involved, the knee reflex may be impaired, which is active in the early stage and then rapidly becomes hyporeflexic. In sacral 1 nerve root involvement, the Achilles tendon reflex is impaired. Reflex changes are more significant for the localization of the involved nerve. The clinical manifestations of lumbar disc herniation are mainly as follows: low back pain, lower to radiating pain, and cauda equina symptoms. The signs of lumbar disc herniation are mainly manifested in lumbar lateral protrusion, restricted lumbar movement, pressure pain, percussion pain and spasm of sacrospinous muscle, etc. Now that you know these characteristics about the disease, shouldn’t you examine yourself and your friends around you?