Lumbar Disc Herniation It is estimated that approximately 80% of people suffer from low back pain at some point in their lives. The National Center for Health Statistics reports that injuries to the spine and low back are listed as the most common cause of activity limitations in people under the age of 45. Lumbar spine disorders are common and prevalent and have a significant impact on people’s work and life, and they can be very difficult to treat. It is now the case that sciatica has become a household name among the spine patient population and lumbar discectomy is one of the most performed procedures in the world. This issue explains self-examination of lumbar disc herniation: lumbar mobility The diagnosis of lumbar disc herniation should first rely on a lumbar mobility examination. Because of its intermittent onset, what is seen on examination in a patient with a lumbar disc herniation may be varied. A herniated lumbar disc usually presents with an acute onset of pain with significant spasm of the paravertebral muscles, and the muscle spasm persists during walking activities. If there are signs of nerve root irritation, they are usually centered on the walking behavior of the sciatic nerve and are seen in the proximal sciatic notch and the distal popliteal fossa. In addition to this, pulling the sciatic nerve at the knee can produce pain in the buttocks and thighs and calves (i.e., pain beyond the knee). Straight leg raise test The Lasègue test (straight leg raise test) is often positive on the affected side. This test has a history of more than 100 years. It was first noted by Dr. Forst, a French physician, in 1881 and has been used ever since, apparently with good clinical value. The L4 nerve root can move 1.5 mm, the L5 nerve root can move 3 mm, and the S1 nerve root can move 4 mm under straight leg elevation. The patient is asked to lie on his back with both lower extremities straight, and the physician places one hand on the knee joint to keep the lower extremity straight, while the other hand lifts the lower extremity. A normal person can lift 80~90 degrees, if the elevation is less than 70 degrees, there will be radiating pain from top to bottom, which is a positive straight leg elevation test. At this time, the straightened affected limb is dropped 5°, and then the foot is dorsiflexed, and if there is discharge pain, it is called a positive reinforcement test (Braqard’s sign). Nerve root symptoms 1. Lumbar 4 nerve root compression: sensory impairment: posterior external thigh, anterior knee and medial calf; muscle weakness: quadriceps (possible) internal hip retractor (possible); abnormal reflexes: knee reflex, tibialis anterior tendon (possible). The numb area is on the anterior medial aspect of the calf. Anterior tibial muscle strength may be reduced, manifesting as unstable heel walking gait. 2. Lumbar 5 nerve root compression: The radicular pain of this nerve root is distributed along the skin segments it innervates, and if numbness is present, it is also distributed along its skin innervation zone, located on the anterolateral aspect of the lower leg and the dorsal aspect of the dorsum and dorsal aspect of the toes. The autonomic zone of the L5 nerve root is located on the web of the first toe and the dorsum of the third toe. Sensory impairment: anterolateral lower leg, toes and dorsal surface of the foot. Decreased muscle strength: gluteus medius, long toe extensor and short toe extensor. Abnormal reflexes: usually no abnormalities, occasionally abnormal posterior tibial muscle reflexes (difficult to elicit). 3. Sacral 1 nerve root compression: manifests as S1 radiculopathy with pain and numbness in the area innervated by S1 nerve roots, including the outer ankle, sole and lateral surface of the foot, occasionally involving the heel. Numbness of the lateral aspect of the lower leg and, more importantly, the skin of the lateral foot and lateral 3 toes is numb. Hypokinesia may manifest in the peroneus longus and shortus (S1), triceps calf (S1), or gluteus maximus (S1) muscles, but hypokinesia is generally uncommon with S1 nerve root lesions, and mild hypokinesia is occasionally seen, manifested by easy fatigue of the above muscles after exercise. The ankle reflex is often dull or absent. Cauda equina syndrome A massive disc herniation or large central herniation that invades the entire lumbar spinal canal can cause low back pain, leg pain, and occasionally perineal pain. Both lower extremities may be paralyzed, with loss of sphincter control and loss of ankle reflexes. A giant disc herniation in any plane of the lumbar region can cause manifestations of cauda equina syndrome: there is saddle area numbness, bilateral loss of ankle reflexes and urinary incontinence as its most constant manifestations. In these cases, intravesical manometry may show loss of innervation of the bladder.