Discogenic lower back pain, which is clinically extremely common and multifactorial, is chronic lower back pain caused by intra-disc disorders (IDD) such as degeneration, intra-fibrotic disc disease, and discitis that stimulate pain receptors within the disc without radicular symptoms, without radiographic evidence of nerve root compression or excessive displacement of vertebral segments, and can be described as chemically mediated discogenic pain.
1. Clinical features
The most important clinical feature of discogenic lower back pain is the decreased tolerance to sitting, and the pain often increases in a sitting position, with the patient usually only able to sit for about 20 minutes. The pain is mainly located in the lower back, but sometimes it can also spread to the lower extremities, and 65% is accompanied by pain below the knee in the lower extremities, but there are no specific signs for diagnosis.
Most patients with lumbar discogenic low back pain can have recurrent episodes of low back pain for a long time. Most patients can further stimulate the nerve endings on the surface of the lumbar intervertebral disc fibrous ring after exertion or prolonged standing, which can cause increased low back pain; in addition, after getting cold, the sensitivity of the nerve endings to adverse stimulation can also be increased, causing increased low back pain. On the contrary, after rest, especially after bed rest, the pressure in the intervertebral disc is reduced, and after good warmth, the nerve endings on the surface of the fibrous ring can be subjected to less adverse stimulation, thus reducing low back pain.
2.What tests should be done for low back pain CT examination
It can clearly show the bones of the anterior and posterior edges of the vertebral body, the site and degree of pressure on the dural sac, spinal cord and nerve roots, and measure the anterior and posterior diameters and transverse diameters of the vertebral canal, and also understand whether there is narrowing of the intervertebral foramen and transverse foramen and whether there is hypertrophy of the vertebral plate.
(1) X-ray film
It is a routine examination for patients with low back pain. Generally, orthogonal, lateral and left-right oblique radiographs should be taken, and if necessary, lateral radiographs of the neck in forward flexion and back extension should be taken. Orthopantomographs may show narrowing of the vertebral space, osteophytes of the hook joint, and thickening of the vertebral arch. Lateral films may reveal loss of cervical physiological protrusion, formation of a bone lip at the anterior and posterior edges of the vertebral body, narrowing of the intervertebral space and narrowing of the spinal canal. An oblique film can determine the condition of the intervertebral foramen.
(2) Magnetic resonance imaging
It can clearly show the posterior protrusion of intervertebral disc tissue, compression of the dural sac and spinal cord, as well as the presence of venous return obstruction, compression, and the presence of cystic lesions in the local spinal cord.
3, life attention to the following aspects.
(1) a balanced diet, protein, vitamin content should be high, fat, cholesterol should be low, prevent obesity, quit smoking and control alcohol.
(2) Pay attention to the combination of work and rest, correct posture, not sitting for a long time, and do preparatory activities before strenuous physical activities.
(3) bed rest, preferably with a hard bed, to maintain the physiological curvature of the spine.
(4) Avoid cold and keep warm.
(5) The principle of prevention requires reducing exercise and relaxing.
(6) The usual should strengthen the back muscle exercise, strengthen the stability of the lumbar spine.
(7) pay attention not to violent large exercise, sedentary work.
Here, we recommend a set of simple and easy to learn exercise exercises for the low back muscle.
① supine, both legs straight lift in turn, the action is easy and slightly faster, to not cause pain, and even do 8-10 times.
② supine, bend the knees, thighs against the abdomen, both hands hold the knees, waist and back against the bed, so that the lumbar muscles and lower back muscles relax, then separate the two hands, legs straight, and do 3-5 times.
③ sit-up, if the sit-up movement is difficult, can be used to hold the bed with two hands to assist, sit up after the body can not be bent forward, and even do 3-5 times.
4.Etiology and pathology
(1) Caused by disorders of the spinal bones and joints and surrounding soft tissues. Such as contusions, sprains caused by local injury, bleeding, edema, adhesions and muscle spasm.
(2) Caused by spinal cord and spinal nerve disorders. Such as back pain caused by spinal cord tumor, myelitis, etc.
(3) Caused by disorders of internal organs. For example, infections and tumors of the uterus and its adnexa can cause lumbosacral pain, and such patients are often accompanied by corresponding gynecological symptoms.
(4) Caused by mental factors. For example, patients with hysteria may also complain of lumbar disease, but there are no objective signs, or the objective examination and subjective narrative cannot be explained by knowledge of physiological anatomy and pathology, and such lumbar pain is often a manifestation of hysteria
5.Why do you have back pain in the morning?
The reason for back pain in the morning is likely to be because of the bed. Traditional brown bandage or nylon silk bandage bed, wire bandage bed and wire bandage marching bed, soft sofa or too soft or less elastic Simmons mattress, etc., will cause people lying on it due to the role of weight, the body presents the central low, four corners of the high state, lumbar muscles in a state of spasm for a long time, so that the intervertebral discs can not get sufficient rest and relaxation, the phenomenon of lumbago. Many people sleep in this kind of bed, the next morning after getting up will feel back pain and weakness, in the long run, very easy to cause lumbar muscle strain, can also induce lumbar disc herniation. The morning back pain caused by this situation, change the bedding can generally improve the symptoms.
If it is not a bedding problem, it may be due to chronic lumbar muscle strain. This kind of back pain, need to do lumbar traction, manipulation massage, Chinese medicine hot compress and oral tendon and blood tablets treatment. In addition, we can take some small measures to prevent back pain in the morning.
(1) Wake up in the morning and move your waist first. Every morning when you get up, you should first move your waist. Usually do more contraction of the abdominal muscles, stretching lumbar muscle exercise, as well as walking, backward walking and cycling, etc., can prevent and reduce back pain.
(2) Learn to relax and reduce tension. Tension can make the blood hormone increase prompted by lumbar disc enlargement and lead to back pain, so reasonable arrangements for work and rest, to maintain a happy state of mind to prevent back pain is very helpful.
(3) Maintain correct posture. No matter what you do, you can’t go against your physiology. Sedentary people sit so that the back against the back of the chair to relax and rest the lumbar muscles, and sometimes stretch backwards is also a good way to prevent back pain.
(4) Improve diet and life, avoid obesity. If the body type has become fat then to implement scientific weight loss. Because obesity will bring excessive load to the spine, while the abdominal muscles can not play a supporting role for the spine due to relaxation, will force the spine to deformation.
6.General therapy
Low back pain in medicine is a symptom, a symptom, itself can send back pain disease is very much, but in general, no more than the following two types of diseases.
(1) Inflammatory diseases, including urinary system infections, genital system infections, this type of disease, active anti-inflammatory treatment can be achieved to heal.
(2) physical and mechanical injuries: these diseases include the common lumbar muscle strain, acute and chronic lumbar sprains, rheumatoid rheumatism, kidney deficiency, herniated discs, lumbar spine osteophytes, etc.. These diseases, can cause lumbar muscle ischemia, calcium deficiency, cold, lumbar muscle ligament fibers overstretched. Or herniated discs or osteophytes trigger nerve compression in the lumbar region, which leads to weakness and pain in the lumbar muscles.
Therefore, from the treatment point of view, activating blood circulation, clearing meridians and stasis, together with the necessary traction and fixation, are the methods we often use to treat lumbar pain, and these methods can be useful for different types of conditions, but the key to the treatment of lumbar pain lies in persistence. Most of the clients’ low back pain is not effectively relieved, repeatedly delayed and not completely cured, because they cannot get the right method and they cannot insist on the treatment. [In this regard, it is recommended that patients with low back pain pay more attention to some domestic medical devices commonly used in daily home treatment, for example, low back pain treatment belts and so on, which are common methods of multifunctional treatment in China. It belongs to the medical equipment products, product design structure both magnetic therapy, heat steam, traction and fixed four effects.
① For low back pain caused by sprain, sedentary, cold and other reasons resulting in poor blood circulation, bruising, edema, etc., it can improve microcirculation and tissue metabolism, promote blood flow and thus achieve pain relief. For low back pain caused by lumbar inflammation and degenerative changes of the lumbar spine, it can improve the activity of pain-causing substances hydrolase, so that pain-causing substances such as bradykinin, histamine and 5-hydroxytryptamine can be hydrolyzed or transformed to achieve pain relief. For kidney deficiency low back pain, involved low back pain, etc., the low back pain treatment belt acts on the body to enhance bioelectromagnetic energy through meridian points, which can promote the operation of meridian qi and unblock meridians to achieve the effect of opening the meridians and relieving pain.
②The unique leather thickened impermeable belt body design ensures that the affected area covered by the belt maintains a high skin temperature and humidity, generating its own heat steam physiotherapy effect, which is conducive to increasing local blood circulation.
③The large cortical belt body is attached with support curvature steel piece, which emphasizes the advantages of traction and fixed treatment, can effectively support the spine and lumbar vertebrae, enhance the contraction force of lumbar muscle, and better treat lumbar pain caused by lumbar disc herniation, ankylosing spondylitis, lumbar vertebral osteophytes, lumbar hypertrophy, spinal stenosis and other conditions.
④ It is very easy to use, you can adjust the lacing according to your body type or comfort level, whether it is walking exercise or ambulatory work or bed rest does not affect the treatment.
Therefore, if we consider it in a comprehensive way, use the right method and pay attention to persistent treatment, the low back pain can be cured.
7.Treatment methods of discogenic low back pain
(1) Non-surgical treatment includes
① Daily home treatment.
(ii) medication.
(3) Traction therapy.
④physical therapy.
(⑤) Tui-na therapy.
⑥acupuncture therapy.
(vii) closure therapy.
(⑧) Small acupuncture therapy.
(2) Included in surgical treatment are.
(① conventional open surgery (including: hemivertebral laminectomy, total laminectomy, transabdominal disc surgery).
(ii) intervertebral discoscopic surgery.
(3) artificial lumbar disc replacement.
8.Minimally invasive interventional therapy
(1) collagenase chemolysis therapy
(2) ozone injection therapy.
(3) percutaneous laser intervertebral disc decompression
(4) radiofrequency thermal coagulation target puncture technology.
9.Physical therapy, massage therapy, acupuncture therapy
Physiotherapy includes electric therapy, three-dimensional traction, Chinese herbal medicine vaporization, heat therapy and other methods, and tui na, acupuncture and other treatment purposes are basically the same. It is mainly to relieve the patient’s clinical symptoms, but not to cure the disease. Since most patients with lumbar synostosis are accompanied by chronic lumbar muscle strain, pear-shaped muscle tension, and muscle spasm in the area where the nerve travels with the lumbar disc herniation, general hospitals will use physiotherapy, massage, acupuncture and other treatments to relieve muscle tension and spasm. Therefore, patients who have had physical therapy will be more comfortable when they have physical therapy. Physiotherapy, massage, acupuncture and other treatments are only used to cooperate with the treatment of lumbar disc herniation, and if the condition is serious, only other treatment methods can be found.
10.Surgical treatment
(1) Conventional open surgery: Conventional open surgery includes: total laminectomy, hemi-laminectomy, transabdominal disc surgery, vertebral body fusion, etc. The purpose of surgery is to directly remove the lesion. The purpose of surgery is to directly remove the nucleus pulposus of the diseased lumbar intervertebral disc and achieve the purpose of treatment by releasing the nerve root compression. Because of the special physiological position of the lumbar spine, surgery destroys the normal physiological structure of the lumbar vertebrae, resulting in large surgical damage, easily causing postoperative instability of the lumbar spine, postoperative scar tissue adhesions, intraoperative accidental injury to nerve roots and a series of adverse reactions, so most patients are afraid of surgery, how to avoid the above adverse reactions caused by surgery? This has been a major problem in the medical field.
(2) Collagenase lysis: The main component of human intervertebral disc is collagen tissue. By using the specific solubility of collagenase to collagen molecules, collagenase can be injected into the herniated part of the disc to destroy and dissolve the collagen component of the herniated material, which can completely achieve the purpose of making the herniated material smaller and disappear, thus relieving nerve compression and improving clinical symptoms.
(3) Ozone nucleolysis (PIMOI): This therapy uses a fine needle to puncture into the intervertebral disc and inject a small amount of ozone gas to dehydrate and shrink the nucleus pulposus to achieve the purpose of decompression of the intervertebral disc. The main principle is to use the instantaneous and powerful oxidation function of ozone to achieve dehydration, anti-inflammatory and analgesic effects.
(4) Percutaneous laser lumbar disc decompression (PLDD): the use of laser energy to cavitate the diseased nucleus pulposus, reduce the pressure within the disc, relieve and eliminate the compression of the sciatic nerve or spinal nerve and achieve the purpose of treatment.
(5) Percutaneous endoscopic discectomy (PED): discoscopy is divided into lateral discoscopy and posterior discoscopy. Lateral discoscopy is an additional discoscopy system based on excision and aspiration. This makes it safer and more effective to perform aspiration under discoscopic monitoring. The posterior approach is a fusion of the advantages of the lateral approach discoscopy and the small interlaminar opening technique, in which only a small opening is made at the corresponding point of the disc lesion and the discoscopy system is inserted, and the process of removing the diseased nucleus pulposus is completed with the use of fine surgical instruments to achieve the purpose of treatment.
(6) Percutaneous lumbar discectomy and aspiration (PLD): Under image monitoring, the working cannula is directly inserted into the disc, and some of the nuclei are removed by using the clamp cutting and negative pressure system, thus reducing the pressure in the disc, making the pressure in the annulus fibrosus lessen and relieving the compression on the nerve root.
(7) The safety principle of radiofrequency thermal coagulation target therapy is highly efficient and safe
The treatment electrode of radiofrequency instrument for nervous system is only 0.7mm, just like an acupuncture needle, the whole treatment does not use anesthesia, analgesics, antibiotics, hormones, only a physical change process, no side effects to human body, it removes the diseased nucleus directly without hurting the normal tissue, making the treatment more green and humanized.
①Precise positioning
Radiofrequency thermal coagulation target treatment is accurately positioned in the C-arm X-ray machine, detected at times under digital subtraction, and directly acts on the lesioned nucleus pulposus under the precise guidance of the navigation system, with data accurate to less than 1mm and angular error less than 1 degree, making the treatment more precise and effective.
②Identify the nerve
The precise identification and stimulation function of the nervous system, which is unique to the neurological system, can measure the nerves within 1cm of the treatment area and distinguish the motor nerves and sensory nerves precisely, which means that it is impossible to damage the patient’s nerves during the treatment.
③Precise tissue identification
The unique impedance display function of this device can accurately distinguish the nucleus pulposus fiber ring, calcification point, bone and blood vessel, and accurately display them with tone and digital, which makes the treatment more accurate and safe.
④Controllable temperature
The radiofrequency instrument can adjust the temperature arbitrarily with the error below 2°C to ensure the safety during the treatment and no infection and thermal damage after the treatment.
⑤ Precise calculation
The volume of lesion to be removed is precisely calculated before the treatment, and a plan is made, which means that as much as the nucleus of the lesion is removed, making the treatment more efficient.
Radiofrequency thermal coagulation target treatment is to directly denature, coagulate, shrink and reduce the volume of the nucleus pulposus in the protruding disease-causing part and release the compression, rarely injuring the normal nucleus pulposus, and directly blocking the release of glycoprotein and beta protein in the nucleus pulposus. No local anesthetics, hormones and antibiotics are needed, which makes the treatment green and safe. The puncture needle for radiofrequency is only 0.2MM thick, so the patient’s pain is minimal during puncture, and the operation is safe. The nerve monitoring function and the controllability of time and temperature will not cause heat damage to the nerve root, and the impedance display can determine the nature of the treated tissue. Radiofrequency targeted therapy for herniated disc is a new minimally invasive treatment method that is highly efficient, safe, simple to operate and less expensive. It is a qualitative leap forward in minimally invasive treatment of disc herniation.
(8) Minimally invasive treatment of discogenic low back pain
Minimally invasive treatment methods for discogenic low back pain include
(i) percutaneous puncture low-temperature plasma myeloplasty.
(ii) percutaneous puncture intervertebral disc radiofrequency treatment.
(iii) percutaneous puncture laser vaporization therapy.
④Joimax intervertebral endoscopic diagnosis plus various radiofrequency, laser and ablation techniques.