[Disease Information] 1, the structure of the intervertebral disc: intervertebral disc lining the spinal column between the vertebrae, for the “sandwich”-like disc-like structure, by the upper and lower cartilage end plate, the middle of the jelly-like nucleus pulposus and the surrounding laminar structure of the annulus. 2, the physiological characteristics of the intervertebral disc: with the human eye, brain, testes, placenta and other structures similar to the intervertebral disc for the immune amnesty organs, the common characteristics of these organs: one with the blood circulation isolation; two for the strategic expression of specific molecules. Normal intervertebral disc is the largest ischemic transport organ in the body. Especially the central nucleus pulposus is not recognized by the body’s immune system. 3, the definition of lumbar disc herniation: refers to the displacement of the contents of the intervertebral disc (annulus fibrosus, nucleus pulposus or cartilage end plate). Displacement into the vertebral body is called Schmidt’s node; displacement is anterior and does not compress the nerves. The lumbar disc herniation we are talking about refers to the displacement to the posterior, due to the posterior nerve root and dural sac and other important structures, will cause lower extremity discharge pain, numbness, serious impact on urination and defecation and walking function. 4, the incidence of lumbar disc herniation: lumbar disc herniation causes radiating pain in the lower limbs, the incidence of which is 2% in the population. 5, lumbar disc herniation and lumbar disc degeneration difference: lumbar disc herniation, and lumbar disc degeneration, the onset of the same site, but the symptoms, pathological mechanisms and treatment are different. According to the latest version of the definition of the North American Spine Society, lumbar disc degeneration includes degeneration that occurs with age and degeneration that is dominated by biochemical pathological changes in the nucleus pulposus, which is mainly manifested as low back pain. 【Preparation for consultation】 1. Record any symptoms that you have: including low back pain or not, the location of low back pain, leg pain or not, low back pain and leg pain is not related; also need to pay attention to the legs with or without numbness, walking has no effect. Can the pain and numbness be relieved by lying down and resting? The situation of urination and defecation also need to be carefully recorded. After the lumbar disc herniation, in addition to the physical compression of the nerve root, the nucleus pulposus and other protrusions protrude, the immune amnesty state breaks down, the body treats the protrusion as a foreign object, the local blood circulation increases, the immune system initiates the immune response chain reaction, through the production of autoantibodies, through the monocyte macrophage, attempts to absorb protruding material, thus triggering a local autoimmune inflammatory reaction. The inflammatory reaction involves the neighboring nerve roots, thus producing numbness, pain, decreased sensation, decreased muscle strength and other symptoms in the area innervated by the nerve root. 2.If you have numbness or radiating pain in your legs, please record the location of your numbness or pain: Due to the anatomical characteristics of the posterior longitudinal ligament of the human spine and the lumbar vertebrae, the most common herniated lumbar discs are the lumbar 4/5 (penultimate section) and lumbar 5 sacral 1 (penultimate section). Lumbar 4/5 disc herniation, compression of the lumbar 5 nerve root, leg pain or numbness site is the lateral calf, dorsum of the foot and big toe; lumbar 5 sacral 1 disc herniation, compression of the sacral 1 nerve root, leg pain or numbness site is the soles of the feet, the dorsum of the foot, lateral and the 2nd-5th toes. Based on these characteristics, you can determine the location and severity of lumbar disc herniation. 3. Record your personal information: your living habits, occupation and characteristics (sedentary, stooping work, heavy manual labor), environment, what diseases you have had in the past (high blood pressure, diabetes, osteoporosis), the diseases you are currently suffering from, and whether there is any lumbar disc herniation in your family. A multinational multicenter study of foreign identical twins showed that genetic factors (74%) play a greater role in lumbar disc disease than environmental factors. Therefore, family history, for patients with lumbar disc herniation, is important. 4. Record what treatments you have had: including bed rest, physical therapy, traction, etc.; record the time and effect of the above treatments. The vast majority of lumbar disc herniation can be relieved or improved by rest and traction with computerized lumbar traction. Due to the special immune amnesty characteristics of the intervertebral disc and the close relationship with the neural structure, collagenase injection, radiofrequency ablation and other treatments are often prone to cause adverse reactions and unreliable results. We hope that our patients will choose carefully. [Your doctor may ask you questions that you can prepare before your visit] 1. What kind of work do you do? Do you usually sit for a long time? Do you often bend down to work? 2.Do you have low back pain? What time of the back pain is obvious? 3.Do you have back pain when you rest at night? Do you have back pain when you get up in the morning? 4.Do you have leg pain? Does the back pain spread to the legs? Where is the part of leg pain? 5.Do you have numbness in your legs? Where is the numbness? 6.Does your back and leg pain affect your walking? How far can you walk before your legs become numb or sleepy? 7.Do you have normal bowel movements? Can you control it as usual? 8.Do you have family members with herniated discs? Is this the first time you have had back pain? 10.What treatment have you had before? Is it effective? Some of the special tests and precautions you may need to take: 1. Physical examination: A well-trained spine surgeon can determine the initial condition based on the symptoms and findings of the examination. Common physical examination includes gait, muscle strength of both lower extremities, skin sensation, muscle tone of both lower extremities, etc. 2, imaging examination: lumbar spine commonly used imaging means include lumbar spine X-ray film: front and side, double oblique and power position film, the advantage of standing position shooting, can be found in the bony structure, sequence of abnormalities, such as slippage, narrowing of the intervertebral space, osteoporosis, isthmus fracture and so on; lumbar spine CT: divided into intervertebral disc scanning and 3D reconstruction, the advantage of scanning according to the intervertebral space, each intervertebral disc can be swept in four images in the cross-sectional section. It can clearly show the structure of lumbar intervertebral disc, spinal canal and articular process; the disadvantage of the above two examinations is that they are radioactive. Women and men of childbearing age and pregnant women are not allowed to do it; lumbar MRI: it can clearly display the lumbar vertebrae, intervertebral discs, nerve roots, cauda equina, articular eminence and other structures in different planes, including the degree of protrusion, the relationship with the nerve root, the water content and degeneration degree of the entire lumbar intervertebral discs, and degeneration of small articular eminence and effusion situation. The disadvantage is that those who have metal implants cannot be examined; CT and MRI are lying down, and some patients with mild lumbar spondylolisthesis and isthmic fissure are easy to be missed. Therefore, the above imaging tests, each has its own advantages and disadvantages, and the advantages complement each other. Not all low back pain is caused by disc herniation, low back pain combined with leg pain, numbness, before considering lumbar disc herniation, lumbar CT or MRI is feasible. many patients with low back pain, the possible causes include lumbar disc degeneration, osteoporosis, muscular strain, inflammation (eg, ankylosing spondylitis), tumors and so on. [Precautions after consultation] 1. Patients diagnosed with lumbar intervertebral disc herniation do not need to have too much psychological pressure. In the work and life of work and rest, do not sit for a long time, because the lumbar spine in the sitting position is more force than standing, so white-collar workers in the sitting work for about 1 hour, can stand up and move the lumbar spine and cervical spine. 2, lumbar disc herniation, rest, traction, change bad habits, the vast majority of conservative treatment is effective. Be careful to choose the so-called collagenase, radiofrequency ablation and other therapies between surgery and conservative treatment. 3, serious back and leg pain, affecting work, study and life, especially lying down also pain, affecting the night rest, indicating that the nerve compression is serious, you can choose to operate in the regular hospital treatment. 4, the choice of anesthesia: in view of the general anesthesia drugs on the human brain cognitive and memory function of the impact, is still in clinical research, and a one-time epidural anesthesia is safe and effective. Unless there are contraindications to epidural anesthesia.