Lumbar disc herniation is a disorder characterized by low back pain and lower limb sciatic nerve radiating pain due to degenerative changes in the lumbar intervertebral disc and the rupture of the annulus fibrosus and protrusion of the nucleus pulposus under the action of external forces, causing irritation or compression of nerve roots. It is also one of the most common clinical causes of low back and leg pain. Etiology and mechanism: Most patients develop the disease due to lumbar sprain or strain, and a few may have no obvious history of trauma. Two vertebrae are connected by intervertebral discs, which constitute the weight-bearing joints of the vertebrae and are the hub of spinal activity. Each intervertebral disc consists of three parts: the annulus fibrosus, the nucleus pulposus, and the cartilaginous disc. The nucleus pulposus tissue is semi-colloid or jelly-like in young age, and its water gradually decreases with age, and later the nucleus pulposus becomes granular and fragile and fragile degenerative tissue. The cartilaginous plate is located above and below and is composed of hyaline cartilage. The lumbar intervertebral disc has great elasticity and plays the role of stabilizing the spine and cushioning shock. When the waist is flexed forward, the disc is weight-bearing in front and the nucleus pulposus moves backward; when the waist is extended backward, the disc is weight-bearing behind and the nucleus pulposus moves forward. With the growth of age and in daily life, the intervertebral disc is constantly subjected to external forces such as extrusion, tension and torsion of the longitudinal axis of the spine, so that the intervertebral disc constantly undergoes degenerative changes, the water content of the nucleus pulposus gradually decreases and loses elasticity, followed by narrowing of the intervertebral space, laxity of the surrounding ligaments or fissures, forming the endogenous cause of lumbar disc herniation; acute or chronic injury is the exogenous cause of lumbar disc herniation When the lumbar intervertebral disc is suddenly or continuously subjected to the action of unbalanced external force, such as bending over to extract heavy objects, moving or lifting heavy objects with improper posture or inadequate preparation, or jerking out after a long period of bending over, the pressure on the posterior part of the intervertebral disc increases, and even due to the slight twisting of the waist, such as when bending over to wash the face, sneezing or coughing, the rupture of the fibrous ring occurs and the nucleus pulposus comes out to the posterior side or the posterior lateral side. When the fibrous disc ruptures, the protruding nucleus pulposus compresses or squeezes the dura mater and nerve roots, which is the root cause of low back pain. If the nerve roots are not compressed, only the posterior longitudinal ligament is stimulated, and low back pain is the main cause. If the posterior longitudinal ligament is breached and the nerve root is compressed, the leg pain will be the main cause. If the nerve root is compressed for a long time, it will lead to partial nerve dysfunction, so in addition to radiating pain, there is also hyperalgesia, weakened tendon reflex or even disappearance of the dominant area. The main point of diagnosis is that most of them have different degrees of history of lumbar trauma. 1. The main symptoms are low back pain and sciatic nerve radiating pain of lower limbs. Low back pain can be aggravated by coughing, sneezing, forceful defecation and other intra-abdominal pressure increase, walking, bending, knee extension and sitting and other movements that pull the nerve roots also make the pain worse, lumbar forward flexion activities are limited, hip flexion and knee flexion, bed rest can make the pain reduced. In severe cases, the patient is bedridden and has great difficulty in turning over. In long-standing cases, the lower extremity radiating pain area feels numb, cold and weak. The symptoms of cauda equina compression due to central protrusion are numbness and tingling in the perineum, dysfunction of the second stool, impotence or incomplete functional paralysis of both lower limbs. In a few cases, the initial symptom is leg pain, while the lumbar pain is not very obvious. 2. Main signs (1) Lumbar deformity: tension and spasm of the lumbar muscles, reduction or disappearance of the physiological anterior convexity of the lumbar vertebrae, or even the appearance of retroconvex deformity. There are different degrees of scoliosis. When the protrusion presses the nerve root below (axillary type), the spine bends to the affected side, and when the protrusion presses the nerve root above (supra-shoulder type), the spine bends to the healthy side. (2) Lumbar pressure pain and percussion pain: there is pressure pain and snap pain next to the spinous process of the herniated intervertebral space, and it radiates down the posterior side of the affected thigh to the lateral side of the calf. There is pressure pain along the sciatic nerve. (3) Restriction of lumbar movement: abnormal skin sensation in the area innervated by the affected nerve roots, mostly skin irritation in the early stage, and gradually numbness, tingling and hyperalgesia. Herniated discs of lumbar 3 and 4 compress the nerve root of lumbar 4, causing abnormal skin sensation in the anterior medial side of the calf; herniated discs of lumbar 4 and 5 compress the nerve root of lumbar 5, causing abnormal skin sensation in the anterolateral side of the calf, anteromedial side of the dorsum of the foot and the sole of the foot; herniated discs of lumbar 5 and sacral 1 compress the nerve root of sacral 1, causing abnormal skin sensation in the posterior lateral side of the calf and the lateral side of the dorsum of the foot; central type herniation shows numbness in the saddle area, bladder and anal sphincter dysfunction. (4) Skin sensory disorder: abnormal skin sensation in the area innervated by the affected nerve, mostly skin allergy in the early stage, and gradually numbness, tingling or hypoesthesia. The herniated discs of lumbar 3 and 4, which compress the nerve root of lumbar 4, cause abnormal skin sensation in the anteromedial calf; the herniated discs of lumbar 4 and 5, which compress the nerve root of lumbar 5, cause skin abnormalities in the anterolateral calf, anteromedial dorsum of the foot and plantar foot; the central type herniation manifests as numbness in the saddle area and dysfunction of the bladder and anal sphincter. (5) Hypotonia or myasthenia: the muscles innervated by the compressed nerve roots may show hypotonia and myasthenia. Compression of the lumbar 4 nerve root causes hypotonia and muscle atrophy of the quadriceps muscle (innervated by the femoral nerve); compression of the lumbar 5 nerve root causes hypotonia of the extensor muscle; compression of the sacral 1 nerve root causes hypotonia of the ankle plantarflexion and standing single-legged heel crossing. (6) Weak or absent tendon reflexes: compression of the lumbar 4 nerve root caused weak or absent knee reflexes; compression of the sacral 1 nerve root caused weak or absent Achilles tendon reflexes. (7) Positive straight leg raise test and positive strengthening test; positive flexion neck test, that is, passive forward flexion of the head and neck, so that the dural sac moves to the cephalad side, and the tension effect increases the pressure on the nerve root, which causes the affected neuralgia; positive supine jerk test and jugular vein compression test, that is, compression of the patient’s internal jugular vein, which temporarily obstructs the return of cerebrospinal fluid, swells the dura mater, and squeezes the nerve root and the herniated intervertebral disc. The nerve roots and the herniated disc are squeezed, causing back and leg pain; positive femoral nerve pull test is a sign of upper lumbar disc herniation. 3. X-ray examination (1) X-ray radiography: orthopantomographs can show lumbar lordosis, narrowing of the vertebral space or unequal left and right, with a wider space on the affected side. The lateral film shows that the anterior convexity of the lumbar spine disappears, or even the posterior convexity of the lumbar spine is reversed, the intervertebral space is equally wide in front and behind or narrow in front and wide in the back, and the vertebral body can be seen to have changes such as the humeral nodes, or degenerative changes such as lip-like hyperplasia of the vertebral body edge. the X-ray plain film must be consistent with the clinical signs and positioning to be meaningful, mainly excluding lumbosacral neuralgia caused by bone disease, such as tuberculosis and tumor. (2) Spine imaging: myelography can show the specific situation of disc protrusion; subarachnoid imaging can observe the subarachnoid space, and can reflect more accurately the degree of dural pressure and the site of pressure, as well as the site and degree of disc protrusion; epidural imaging can depict the outline of the dura and the course of nerve roots, reflecting the condition of nerve root compression. 4.Other examinations (1) electromyography: the distribution of abnormal electromyography can determine the damaged nerve roots and the degree of their influence on the muscles. (2) CT, MRI examination: It can clearly show the morphology of the spinal canal, the anatomical location of the herniated nucleus pulposus and the compression of the nerve roots in the dural bursa, and if necessary, it can be contrasted. Treatment: Manipulation therapy is the main treatment, together with traction, medicine, bed rest and gong practice, etc., if necessary, surgery. 1, tendon manipulation: 2, drug treatment: the acute stage or the early stage should be blood activation and tendon relaxation, can be used to Shu Shu tendon and blood activation soup plus reduction; chronic stage or long duration of the disease, the body is more deficient, treatment should be nourishing the liver and kidney, promote paralysis and activation, internal medicine, such as tonifying the kidney and strengthening tendon soup; with wind, cold and damp, it is appropriate to warm up the meridians, the formula with the Great Active Ligament Dan. 3, traction treatment: mainly using the pelvic traction method, for the first traction attack or repeated attacks of acute patients, patients lying on their backs, in the lumbar and crotch tied pelvic traction belt, each side with 10 ~ 15 kg of weight for traction, and raise the end of the bed to increase the force against traction, traction once a day, each time about 30 minutes, 10 times for a course of treatment. At present, there are various mechanical traction bed, computer-controlled traction bed instead of the traditional traction method. 4.Practice activities: After the symptoms of lumbar and leg pain are reduced, the functional exercise of lumbar and back muscles should be actively carried out, and the practice of Feiyan pointing water and five-point support can be used. 5.Surgical treatment: After the above treatment, most of the patients’ symptoms can be relieved or disappear completely, but the symptoms can be repeatedly recurred, and each recurrence can be aggravated and last longer, and the interval of the attack can be gradually shortened. Long duration of disease, recurrent attacks, severe symptoms and central type protrusion compressing the cauda equina nerve can be treated surgically. Laminectomy and nucleus pulposus removal or percutaneous perforator nucleus pulposus extraction can be performed. The choice of surgical method depends on the patient’s condition, the operator’s experience and equipment. 6, prevention and conditioning: the acute period should be strictly hard bed for 3 weeks, and bed rest after manipulation treatment, so that the damaged tissue repair. After the pain is reduced, attention should be paid to strengthen the exercise of the lumbar back muscle to consolidate the effect. When sitting or standing for a long time, wear a lumbar brace to protect the lumbar region and avoid excessive flexion or strain of the lumbar region or wind and cold. Bend and carry things in a correct posture to avoid lumbar injury.