With the opening of the second child policy, more and more women over 35 years old are joining the ranks of mothers preparing for pregnancy. As we all know, women’s organism is in a downward trend after 35 years old, not only the incidence of fetal malformation increases, but also the complications during pregnancy increase, which is medically called as senior pregnant women. Therefore, if you are a senior pregnant woman, you have to carry out more careful pre-pregnancy preparation and pregnancy check-ups than younger mothers. As an orthopedic surgeon, we often encounter anxious women in the clinic, like the patient mentioned before, who are concerned about whether they can still get pregnant with a herniated lumbar disc? What preparations are needed? 1. What is lumbar disc herniation? We know that the lumbar spine is the pivot of the body’s weight-bearing and activity, and the intervertebral disc is equivalent to the joint part between adjacent vertebrae, a disc-shaped fibrocartilage tissue, composed of nucleus pulposus, fibrous ring and cartilage end plate, with elasticity, can absorb and disperse the role of spinal load. With increasing age, disc degeneration increases, eventually leading to a decrease in disc elasticity and load resistance. If the pressure exerted on the intervertebral disc exceeds what the disc can withstand, it will lead to the rupture of the fibrous ring and the nucleus pulposus will protrude backwards from the fibrous ring rupture, stimulating and compressing the spinal nerve and producing sciatica as the main manifestation of lumbar and leg pain disease. 2.After pregnancy, why do you have low back pain? According to statistics, about 60% of women will experience low back pain during pregnancy. This is mainly because with the needs of the mother and the fetus, the mother has to have a lot of nutritional reserves, and at the same time there will be the retention of their own body fluids and the weight of the baby itself, which significantly increases the weight of the mothers and intensifies the load on the lumbar spine of the mother; coupled with the forward shift of the mother’s body weight, resulting in an increase in the physiological lumbar convexity and posterior convexity of the chest, which will also increase its posterior support tissue and intervertebral disc load; on the other hand, influenced by the hormones , women during pregnancy will have pelvic pain. On the other hand, under the influence of hormones, women during pregnancy will have pelvic expansion, as well as the relaxation of the systemic ligament system, resulting in the instability and displacement of the small joints of the vertebral body, and the relaxation of the posterior longitudinal ligament is more likely to make the disc bulge and protrude, resulting in low back pain and radiated pain in the lower limbs. 3, so as long as the back pain is lumbar protrusion? Not all low back pain during pregnancy is related to lumbar protrusion, the causes of low back pain during pregnancy may not be single. First of all, with the increase of hormone level, the level of relaxin increases, leading to the relaxation of the ligaments throughout the body, the strength decreases, especially the sacroiliac joint capsule will become lax and thinner than normal, leading to a mild separation of the sacroiliac joint during a mild forceful pull, and in severe cases the sacroiliac joint may be detached from the joint surface by as much as 1 cm! Moreover, the significant increase in anterior pelvic tilt, which pulls the muscles around the lumbar region, can also cause low back pain due to compression of the nerves in the lumbar region. Secondly, as the uterus grows and the body’s center of gravity shifts forward, mothers usually make their lumbar region excessively convex in order to maintain balance. This prolonged muscle tightness can also cause muscle pain. And in late pregnancy, as the pregnant uterus further increases in size, it can directly compress the nerve roots, as well as due to the pressure of the uterus on the aorta and vena cava, so the poor blood flow and local ischemia of the nerves may also lead to low back pain, as well as pain radiating to the legs. 4, since this lumbar protrusion patients can still have a baby? According to the survey, 70% of women will have low back pain in their lifetime, only about 20% of them are due to lumbar disc herniation, and the real low back pain caused by lumbar disc herniation during pregnancy or puerperium is even rarer, so mothers can rest assured. And according to a study done in Chongqing, China on pregnancy-related low back pain, lumbar disc herniation is rarely the real cause of low back pain during pregnancy. However, what should female patients who have been diagnosed with lumbar disc herniation before they become pregnant do? We recommend to develop an individualized treatment plan based on clinical symptoms, signs and the severity of the lumbar disc herniation on imaging. Our pregnant mothers should seek professional consultation with an orthopedic (spine surgery) doctor. A small percentage of female patients with lumbar herniation may require surgery first, while most can be treated conservatively. We recommend strengthening the lumbar back muscles during pregnancy preparation, which can increase the spine It can increase the stability of the spine, reduce the load on the intervertebral discs, and also loosen the soft tissues of adhesions and promote the absorption of inflammation in the lumbar region. Note that this exercise should be carried out during the remission period of lumbar protrusion and requires professional guidance from a doctor, and can also be carried out more safely during pregnancy under the guidance of a professional. 5, conservative treatment during pregnancy In general, if a pregnant woman has a lumbar protrusion, the first thing to do is to take conservative treatment. Mainly bed rest and appropriate functional exercise, together with hot compresses and reasonable lifestyle habits, if necessary, can be given drugs to relieve pain (need to be cautious). Bed rest During the acute lumbar protrusion period, bed rest should be kept as much as possible. It is recommended to choose a mattress of suitable hardness to maintain a good curvature of the spine. The posture should keep the head and neck naturally supine and the body flat, so that the knees and hips can be slightly flexed. This position can release the muscle contraction and the intervertebral ligament tension on the intervertebral discs caused by the squeeze, so that the ligaments get maximum relaxation and rest, so that the pain symptoms will be significantly reduced or gradually disappear. For pregnant women who find it difficult to lie on their backs, they can adopt a lateral position and keep both knees and hips bent, using a pillow to support the weight of the uterus, or placing a pillow between the two knees to reduce the weight bearing on the back. Lifestyle Pay attention to protection against cold and warmth, as cold is an important trigger for lumbar disc herniation. Heat therapy and massage can be applied to the painful area to promote local muscle blood circulation and relieve muscle tension. For pregnant women who have difficulty relieving pain, they can take some medication. However, it should be noted that non-steroidal anti-inflammatory drugs are prohibited during pregnancy, and only a few analgesics such as acetaminophen are relatively safe, so it is important to consult your doctor when taking medication. It is recommended to avoid taking painkillers as much as possible if the pain is still tolerable, and when the symptoms of low back pain worsen, you should go to the hospital as soon as possible. How to protect the lumbar spine In the case of ensuring the right amount of exercise, as far as possible to reduce physical labor, especially in lifting objects, should try to avoid two knees straight bending position lifting heavy objects, but should try to take a squatting, bending knees and keep the back straight posture to reduce the burden on the lumbar region; long-term lying, sitting, standing position can cause pain, should be alternately minimized to maintain the same position for a long time.