1.What is lumbar disc herniation? Lumbar disc herniation is one of the more common orthopedic disorders, mainly because the lumbar intervertebral disc (including the nucleus pulposus, fibrous ring and cartilage plate) exists in different degrees of degeneration, under the action of external factors, the fibrous ring of the intervertebral disc ruptures, the nucleus pulposus protrudes (or prolapses) from the rupture in the posterior or spinal canal, resulting in adjacent nerve stimulation or compression, resulting in lumbar pain, numbness in one or both lower limbs, pain and a series of clinical symptoms. The incidence of lumbar disc herniation is highest in the lumbar 4-5 and lumbar 5-sacral 1 discs, accounting for about 90% to 96%. 2. Is a lumbar disc herniation a lumbar disc herniation? The lumbar disc herniation is only a pathological phenomenon, when the fibrous ring ruptures, the nucleus pulposus protrudes, the image can be seen as lumbar disc protrusion or prolapse, but no clinical symptoms such as back and leg pain, we call it “disc protrusion”, can be no back pain and other clinical symptoms; when the protruding disc compresses the nerve root, and clinical manifestations such as lumbar pain or lower limb pain appear, only then can it be called “lumbar disc herniation”. 3.What are the common symptoms of lumbar disc herniation? (1) Low back pain, aggravated by activity and often relieved by bed rest; (2) Lower extremity conductive pain, generally from the lower back to the buttocks, the back of the thigh, the outer calf to the foot, which may increase with sneezing and coughing, etc. Generally, one side of the lower extremity is involved, and only a very small number of herniated patients show symptoms of both lower extremities; in the early stage, pain sensation is hyperalgesia, and in severe cases, sensory dullness or numbness occurs; (3) Compression of the cauda equina nerve, mainly manifesting as nerve root compression. (3) compression of the cauda equina nerve, mainly manifesting as obstruction of urination and defecation, 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 clinically; (4) intermittent claudication, due to compression of the nerve roots by the lumbar disc protrusion, resulting in inflammatory reactions and ischemia of the nerve roots such as congestion and edema. when walking, the vertebral venous plexus in the spinal canal is congested, which increases the congestion of the nerve roots The degree of congestion and the expansion of spinal blood vessels also aggravate the compression of the nerve roots and cause pain. (5) Changes in spinal posture. About 90% of patients with disc herniation have varying degrees of functional scoliosis, mostly to the affected side and a few to the healthy side, depending on the position of the herniation in relation to the nerve roots. 4, what kind of people are prone to lumbar disc herniation? (1) occupation: lumbar disc herniation can be seen in all walks of life, there is no significant difference between manual and mental workers. heavy manual workers are more likely to get it than light manual workers, pure mental workers are higher than light manual and mixed mental and physical workers; (2) age: the disease generally occurs in young adults between 20 and 40 years old, more men than women; (3) body type: generally too obese or too thin (4) working environment: cold and humid working and living environment is prone to lumbar disc disease; (5) heredity: people who have had lumbar disc herniation in their family have several times higher incidence than those who do not have the disease in their family; (6) development: patients with developmental abnormalities, such as lumbar sacralization, sacral lumbarization, sacral fracture, and disintegration of the vertebral arch, can affect the normal function of the lumbar spine The lumbar disc herniation is easily induced by adding extra load to the lumbar muscles; (7) physical quality: some people suffering from lumbar disc herniation usually have better physical quality, and few of these patients suffer from common diseases such as hypertension, coronary heart disease and diabetes at the same time. 5, is lumbar disc herniation hereditary? Lumbar disc herniation has a certain degree of heredity, but it does not necessarily develop in the father’s generation, but also in the children’s generation, but the possibility of the children’s generation is higher. 6.My back does not hurt, why is it lumbar disc herniation? The majority of patients with lumbar disc herniation can be said to have a history of lumbar pain of varying lengths, and lumbar pain is one of the main symptoms; however, not 100% of patients with lumbar herniation have lumbar pain symptoms, the reasons for which may be the following: (1) degeneration-induced lumbar disc herniation: this type of lumbar herniation, generally slow onset, longer course, disc herniation gradually formed, the tissue around the lumbar spine is very little stimulation, so there may be no lumbar The herniated disc gradually adheres to the nerve roots, and leg pain is the main cause at this time; (2) high lumbar disc herniation: in high lumbar disc herniation (above lumbar 3 and 4), the proportion of lumbar pain is not very large; (3) recovery period of lumbar disc herniation: most of the patients with lumbar disc herniation have been rested and treated, so that the symptoms of lumbar disc herniation are basically eliminated. The symptoms of lumbar disc herniation are basically eliminated, and at this time there can be no symptoms of lumbar pain at all. 7. Is lumbar pain a lumbar disc herniation? No. The causes of lumbar pain are many and varied. The causes of lumbar pain are diverse, according to statistics, only 35% of the adult population with lumbar pain are patients with lumbar disc herniation, while most of the lumbar pain is caused by other factors, such as lumbar muscle strain and injury to the supraspinous and interspinous ligaments, lumbar spine tuberculosis and tumors. 8.What about lumbar spine osteophytes? The data shows that 90% of women over 60 years old and men over 50 years old can have different degrees of vertebral osteophytes, that is, bone spurs, but most of them do not have clinical symptoms, so osteophytes and degenerative changes are a physiological and pathological process and are not a terrible phenomenon. It is generally believed that osteophytes are not a disease but a protective reaction of the body and are normal. The vertebral osteophytes are just like a few claws that increase the stability of the vertebral body and help prevent disc protrusion. 9.Does smoking have an effect on lumbar disc herniation? The reason smoking has a greater impact on the recovery of patients with lumbar back pain is that smokers have increased respiratory disease, coughing causes strong contraction of the abdominal and dorsal muscles and increases intra-abdominal pressure, thus increasing the internal pressure of the disc. Smoking does not directly affect herniated lumbar discs, but can cause coughing, which can directly and rapidly increase abdominal pressure, leading to increased pressure in the lumbar spinal canal, prompting or increasing the protrusion of discs and compression of nerves, resulting in a series of symptoms. So people who are addicted to smoking and coughing should not smoke as much as possible. 10, lumbar disc herniation, why does my leg hurt? Many people do not understand why the lumbar spine disease causes leg pain. In fact, it is because the herniated disc compresses the nerves that govern the sensation and movement of the lower extremities, so it causes pain in the lower extremities, which is characterized by radiating pain that can radiate along the buttocks to the back of the thigh, lateral calf or posterior lateral, and some patients can also radiate to the ankle, dorsum of the foot or sole of the foot, which can be accompanied by numbness, coldness and weakness of the limbs. The above pain can be aggravated when coughing, sneezing or straining to defecate, and can be alleviated or relieved when resting. 11. Can imaging examination exclude lumbar disc herniation? The diagnosis of lumbar disc herniation is based on a combination of clinical symptoms (low back pain and lower extremity radiating pain), physical examination (signs corresponding to nerve damage, sensorimotor disorders, abnormalities in urination and defecation) and imaging examination (showing the location, direction and degree of lumbar disc herniation), and cannot completely exclude lumbar disc herniation if the imaging examination is normal. The false positive rate of MRI is very low (less than 10%) for the diagnosis of lumbar disc herniation. 12. What tests can diagnose lumbar disc herniation? There is no single test that can diagnose lumbar disc herniation. CT examination shows the location, size and shape of the herniated disc and the displacement of the nerve roots and dural sac under pressure, as well as hypertrophy of the vertebral plate and ligamentum flavum, hyperplasia of the small joints, narrowing of the spinal canal and lateral saphenous fossa, etc. MRI examination is important for the diagnosis of disc herniation. MRI is important for the diagnosis of disc herniation. It allows observation of the morphology of the herniated disc and its relationship to the surrounding tissues. For patients who cannot undergo MRI examination, myelography can also be performed with high accuracy. 13.Why do patients with lumbar disc herniation need X-rays, CT and MRI, but only one of them is needed? X-rays, CT and MRI have their own advantages and disadvantages and are complementary. Patients with lumbar disc herniation who go to the hospital will first have an X-ray to rule out other bony lesions. CT is considered for patients with lumbar disc herniation who suspect a bone abnormality (e.g., a narrow fracture). Magnetic resonance imaging (MRI) is an examination of the soft tissues (site and direction of disc herniation, spinal nerve root compression) and is a common test for the diagnosis of lumbar disc herniation in addition to clinical history and physical examination. If only X-rays and CT examinations are performed without MRI, important diseases of the adjacent segments, such as tumors, are often left behind. X-rays and MRI alone, without CT, often leave behind calcified disc herniation, which can affect the extent of surgery. CT and MRI alone, without X-ray, may miss the determination of isthmic fissure and lumbar instability. 14.Is a bulging disc on CT examination a lumbar disc herniation? A bulging lumbar disc means that the annulus fibrosus has been damaged but has not yet ruptured, and is a subluxation of the disc. Since the fibrous ring of the disc is intact, there is no nucleus pulposus falling out, and there is no irritation to local tissues and nerves, so there are mostly no clinical symptoms or only slight local pain, which cannot be called lumbar disc herniation. 15.How can I prevent lumbar disc herniation in daily life? The general principle is to avoid or reduce bending as much as possible: (1) Be careful when mopping, sweeping or vacuuming in your daily life, and try to keep your body upright; when picking up something from the ground, it is better to keep your body in an upright position above the waist and squat first, rather than bending down to pick it up directly. When picking up something from a high place, it is strictly forbidden to lean the body backwards and keep it upright. When holding a child is best close to their own body, too far away will increase the burden on the waist; (2) do not maintain a posture for a long time, to avoid overwork, work a little exercise after a period of time, or massage the waist and legs, or do a while gymnastics, and maintain the correct posture to relieve tension in the lumbar muscles; (3) walking more use of abdominal muscles, when standing do not stand with both legs together for a long time; (4 (4) sleep on a hard bed with moderate hardness and softness, do not watch TV for a long time after meals; (5) avoid cold, humid living and working environment, pay attention to avoid the recurrence of lumbar spine disease in the season of cold and heat; (6) a simple way to exercise the lumbar spine: sit on a chair, cross your hands and hold your neck, hold your abdomen forward and tilt your head backward, insist on 2~3 minutes and then relax, between work, repeat the above action three or five times, which is good for the cervical spine The cervical spine, lumbar spine have a very good stretching effect. 16, suffering from lumbar disc herniation, how to exercise is good? (1) bed, toe hook back, leg straight up to the highest and adhere to 5 seconds, and then slowly put down, cycle 10 times, left and right leg exchange do. (2) arch bridge exercise: lying on the bed, both elbows and feet propped up on the bed, the hips lift upward to the highest insist 5-10 seconds, cycle 10 times. (3) swallow fly: prone on the bed, arms stretched backward, legs upward to the highest, adhere to 5-10 seconds, cycle 10 times. Patients with lumbar disc herniation must pay attention to gradual and persistent exercise. 17.Will lumbar disc herniation paralyze? Lumbar disc herniation has the potential to cause paralysis, but the majority of patients with lumbar disc herniation will not be paralyzed with active treatment. The main pathological change of lumbar disc herniation is the compression of the nerve root by the herniated disc. This condition is mostly seen in lumbar 4~5 disc herniation, which mainly manifests as foot drop and muscle weakness. Triceps paresis due to discs in lumbar 5 to sacral 1 is rare clinically. Paralysis of these local muscles will be significantly relieved with effective treatment and paralysis is unlikely to occur. 18. What treatments are available for lumbar disc herniation? On the whole, most patients with lumbar disc herniation are still treated conservatively, and there are various methods of conservative treatment, which are chosen according to the different conditions of the patient: (1) First of all, bed rest is the most basic and important basic treatment, because the intervertebral disc plays the role of supporting weight in normal life, and when standing upright or sitting, the disc has to bear a lot of weight, and at this time the pressure inside The pressure is very high and the pressure on the nerve roots is correspondingly heavy. Most people are not very heavy lumbar disc herniation, such as bulging, through bed, the entire spine is completely relaxed, the pressure of the intervertebral disc is reduced, its compression of the nerve root is reduced, at the same time, some patients after the intervertebral disc compression of the nerve root, the nerve root itself will be some inflammation, you bed rest, after the pressure of the intervertebral disc is light, the nerve swelling will slowly recede, in fact, also achieve the purpose of treatment 80% of patients are treated conservatively. If conservative treatment does not solve the problem, some other methods should be sought. (2) Certain drugs can also play a better role, these drugs are mainly for the inflammatory response, reduce the edema of the nerve root, reduce the local inflammatory response, through these measures to play the role of pain relief. (3) Then there is surgery, according to different conditions, can choose different surgical methods. 19, can traction cure lumbar disc herniation? Traction belongs to physical therapy, only temporarily alleviate clinical symptoms, reduce the pressure within the disc, through traction can not completely cure lumbar disc herniation. 20.Can traction and massage press the herniated disc back? No. The method can make the spastic back muscles relax, which can relieve or even eliminate the symptoms, but it cannot press the protruding disc back. 21.Is plaster effective for lumbar disc herniation? It is effective in some cases seen clinically and can relieve the symptoms, especially the painful symptoms, but cannot fundamentally solve the lumbar disc herniation. 22.When is surgery required for lumbar disc herniation? (1) Those with clear diagnosis and invalidated by long-term systematic conservative treatment. Some patients should receive surgery if their symptoms do not improve significantly after regular and systematic conservative treatment and the diagnosis is clear by CT or imaging. (2) Those with progressive development of the disease and obvious neurological symptoms. If the patient’s condition worsens, muscle strength weakens, numbness or even sagging in the innervated area, signs of nerve damage appear on physical examination, and the condition of nerve root compression is consistent with the symptoms in combination with CT and imaging, the patient should undergo surgery as early as possible. (3) Lumbar disc herniation combined with other bony lesions of the lumbar spine, requiring surgical treatment or exploration. (4) Those with recurrent symptoms. Surgery should be considered when some patients have significant symptoms that are relieved by non-surgical treatment and then reoccur in less than 6 ~ 8 weeks, affecting normal work, study and life. (5) Acute attacks with obvious cauda equina symptoms. Patients with symptoms of compression of the cauda equina nerve at the onset, such as urinary and fecal disorders, need urgent surgery to remove the intervertebral disc. 23.What are the risks of surgery for lumbar disc herniation? Generally speaking, as long as it is a surgery, there is a certain degree of risk. currently, lumbar disc herniation surgery is a routine surgery, but there are also some risks such as: anesthesia accident, incision bleeding, infection, adjacent disc vascular and nerve injury, postoperative recurrence and other risks. 24.Why is my leg still numb after lumbar disc herniation surgery? Generally speaking, pain is relieved quickly after surgery, and numbness and other sensory abnormalities are recovered slowly. During surgery, the nerve roots are pulled when the disc is removed, so it is inevitable that the nerve roots will be stimulated to some extent, and postoperative sensations such as numbness or mild weakness will occur. If the symptoms do not disappear, but are mild and do not affect your life, do not mind. if the symptoms are heavy, seek further treatment. 25.Does lumbar disc herniation recur after surgery? According to the relevant literature, the recurrence rate of traditional disc surgery is 3% ~ 6%. The causes of recurrence after disc surgery are not only related to the patient’s body type, living habits and work nature, but also related to the surgeon’s surgical skills, choice of surgical method, whether to review regularly and whether to insist on functional training of the lumbar back muscles. 26.After lumbar disc herniation surgery, can I still work? The lumbar spine is not very stable after lumbar spine surgery and is prone to injury or recurrence of disc herniation. After surgery, you cannot work like a normal person, so you need to be more careful and do less bending, lifting, carrying and other labor that increase the weight on your back. 27.Can the herniated disc absorb or shrink on its own? Generally speaking, herniated discs can absorb or shrink by themselves. If the herniated disc is mostly or completely absorbed, the patient is usually younger and the onset time is shorter. If the herniated disc is calcified or ossified, it cannot be absorbed or reduced, and surgery is generally required in such cases. 28.Walking backwards, is it good for lumbar disc herniation? Walking backwards is walking backwards continuously, there are the following benefits: (1) walking backwards can effectively correct the unreasonable posture of the waist (lumbar lordosis), but also exercise their own muscles; (2) walking backwards can exercise the lumbar muscles, quadriceps and muscles around the ankle and knee joints, ligaments, etc., so as to adjust the spine, limb movement function, strengthen the lumbar muscles, and enhance the stability and flexibility of the lumbar spine, correct the physiological curvature of the lumbar spine This can reduce the pressure on the spine and intervertebral discs, and also reduce the pressure on the nerve roots. Therefore, walking backwards is beneficial to alleviate lumbar disc herniation. 29.What do I need to pay attention to on a daily basis if I have a lumbar disc herniation without symptoms? The diagnosis of lumbar disc herniation without symptoms is not established if it is only the result of imaging. If the diagnosis of lumbar disc herniation is made, the symptoms disappear after active conservative treatment. Pay attention to the following points in daily life: (1) Sleeping on a hard bed. Sleeping on a hard bed can reduce the pressure on the intervertebral discs; (2) do not do excessive bending, do not bend when lifting heavy objects, you should first squat to get the heavy objects, and then slowly get up, and avoid long bending and excessive weight bearing; (3) the same position should not be maintained for too long, appropriate in situ activities or lumbar back activities; (4) swimming (breaststroke), backwards walking, etc. can be carried out cervical and lumbar back muscle strength exercises. 30.Is there a prescription for lumbar disc herniation? For the treatment of lumbar disc herniation there is no secret recipe, special medicine or prescription. The disease should be diagnosed formally and treated scientifically. The treatment methods are mainly divided into conservative treatment and surgical treatment. Conservative treatment is mainly through drugs, rest, physical therapy to reduce the symptoms, but conservative treatment can not fundamentally solve the problem of lumbar disc herniation. Surgery is suitable for patients whose symptoms are more serious and have been invalidated by strict conservative treatment, or whose symptoms continue to worsen with recurrent attacks. There are also many different surgical methods, and the doctor will choose the surgical method according to the patient’s age, gender, weight, occupation, subjective requirements, and the degree and extent of lumbar disc herniation and nerve damage.