Definition: It is a syndrome manifested by degeneration of intervertebral disc, rupture of annulus fibrosus, protrusion of nucleus pulposus which stimulates or compresses nerve root and cauda equina, and it is one of the common causes of lumbar and leg pain, with the highest incidence rate of L4-L5 and L5-S1. Etiology: 1, disc degeneration is the most basic factors: lumbar intervertebral disc is the heaviest part of the human body load, lying down L3 disc pressure 20Kg, sitting 270Kg normal intervertebral disc is rich in elasticity and toughness, with a strong resistance to pressure can withstand the pressure of 450Kg without injury, generally believe that after 20 years of age, the disc began to degenerate, but now further proof of the age of 15 years old has appeared! Degeneration, the nucleus pulposus gradually decreases in water content, the elasticity and load resistance of the intervertebral disc also decreases, and the weakest place in the outer and posterior structure, where the stress is most concentrated, produces a fissure from the inside to the outside. 2, injury: daily life lumbar intervertebral disc repeatedly bear extrusion flexion, torsion and other loads, causing cumulative damage to the intervertebral disc in a larger trauma or many times of mild injuries, can make the degeneration and accumulation of damage to the annulus fibrosus to further rupture, so that the degeneration of the nucleus pulposus protrudes into the spinal canal compression of the nerve and the onset of the disease. 3, genetic factors: a family history of a certain 4, pregnancy: pelvic congestion of lower lumbar area, lumbosacral force changes, the pressure increases, increasing the number of intervertebral discs and the number of intervertebral discs. Pressure increases, increasing the chance of intervertebral disc damage. Typing and pathology: from the pathology and CT, MRI findings are divided into: 1, bulging type: partial rupture of the annulus fibrosus, while the surface layer is intact, the nucleus pulposus is limited bulging to the vertebral canal due to the pressure, but the surface is smooth more than can be treated conservatively. 2, protruding type: complete rupture of the annulus fibrosus, nucleus pulposus protruding into the spinal canal only covered by the posterior longitudinal ligament or a layer of fibrous membrane, the surface is uneven or cauliflower-like. Surgical treatment. 3, prolapse free type: rupture and protrusion of the intervertebral disc tissue fragments off into the spinal canal or completely free, not only can cause nerve root symptoms, but also can cause multiple nerve roots, cauda equina symptoms. Surgery. 4, Schmorl nodule and transosseous protrusion type Clinical manifestations: 1, symptoms: (1), low back pain: is the first symptom of the onset, except for individuals have, nucleus pulposus stimulation of the posterior longitudinal ligament, transsinusoidal spinal nerves and the production of lower lumbar symptoms (2), sciatica: L4-5, L5-S1 protruded after the compression of the L5, S1 nerve roots, and the emergence of ① nerve radiculitis ② compression of the nerve roots of the compression of the compression of the compression of the compression of the nerve roots (3) nerve ischemia changes, and It radiates along the posterior femur to the heel of the femur, and can be triggered by sneezing, coughing, or defecation that increases the pressure in the abdomen. It can be unilateral or bilateral, early allergy, late retardation, numbness (3), cauda equina compression: the protrusion is located in the posterior or prolapse compression of the cauda equina nerve appeared in the second bowel obstruction, saddle area sensory abnormality, need emergency surgical treatment. 2, signs: (1), lumbar lateral protrusion, is the patient for symptomatic relief and the use of obsessive-compulsive signs The protrusion is located in the shoulder, then the upper body side to the healthy side, the lumbar protrusion to the affected side The protrusion is located in the axilla, then the upper body side to the affected side, the lumbar protrusion to the healthy side (2), lumbar activities are limited: lumbar anterior and posterior flexion and extension, bilaterally curved are limited, and before the flexion is obvious. (3) Pressure pain and sacrospinous muscle spasm, physical examination found bilateral sacrospinous muscle spasm, lesion interspinous space pressure pain, paracentesis 1cm to 1,5cm pressure pain accompanied by lower limb radiating pain. (4), straight leg raising test and strengthening test (+): normal people have 4mm sliding nerve root, elevation of the patient pulling the nerve root, due to adhesion, edema and pressure, can not be normal sliding and produce pain in the lumbar region and radiate, elevation of 60 ° when the production of symptoms called (+). The symptoms are relieved by dropping the lower limb, passive dorsal extension of the ankle joint, and the pain reappears as a strengthening test (+). If the elevation of the lower limb causes pain in the contralateral lumbar region called cross straight leg raising (+) Laguese (+), flexion of the hip and knee 90 ° stretching and closing the knee triggers pain called Laguese sign (+), equivalent to the straight leg raising test. (5), flexion of the neck test: the whole body is relaxed in the lying position, raise the head and rise up so that the shoulders leave the bed, increase abdominal pressure, causing lumbar pain accompanied by radiating pain in the lower limbs for (+) (6), neurological manifestations: (1) sensory manifestations: 80 have sensory deficits, in accordance with the distribution of the nerve roots of the area of the skin nociceptive allergy or numbness and sluggishness. L5——- anterolateral calf, medial side of the foot S1——- near the outer ankle, lateral side of the foot L4——- medial side of the calf Large protrusions can compress two nerve roots at the same time ② Decrease in muscle strength: L5——- decrease in ankle and mu-toe dorsal extension S1——- decrease in ankle and toe plantarflexion L4——- decrease in quadriceps muscle strength ③ Abnormal reflexes: S1——– ankle reflex, metatarsal reflex Cauda equina ——- decreased anal sphincter tone, anal reflex weakened or disappeared 3, auxiliary examination: (1), X-Ray plain radiographs: does not directly manifest the herniation of the intervertebral discs, but provides some indications of spinal lateral protrusion, osteophytes, vertebral spacial narrowing and other degenerative changes. Rule out other lesions, collapsed pedicles, spondylolisthesis, tuberculosis, bone tumors, etc. Small joint structural disorders. (2), X-Ray contrast: myelography: epidural contrast, spinal venography, less often used. (3) CT and MRI: CT cross section can show clear position of herniated disc and degree of dural compression, MRI is very specific in sagittal plane. Disadvantages: can only take pictures of short segments, can not show the situation of multiple segments, cost more . (4), ultrasound: (5), electrophysiology: can determine the degree and scope of nerve injury, observe the effect of treatment and used for differential diagnosis: 4, diagnosis: history, symptoms, signs, X-Ray, CT, MRI and so on can confirm the diagnosis Differential diagnosis: with low back pain as the main symptomatic diseases to distinguish 1, lumbar muscle strain, supraspinous interspinous ligament injury, no symptoms of nerve injury, the former pressure points are different, ligamentous pressure pain superficial, no deep The pressure points of the former are different, and the pressure pain of the ligament is superficial without deep pressure pain. 2.3rd lumbar transverse process syndrome: the pressure pain is located in the transverse tip of lumbar 3, no nerve symptoms, and the closure is effective. Isthmus fracture and spondylolisthesis: X-Ray can also be used to understand the fracture position and spondylolisthesis. 4, lumbar spine tuberculosis and tumor X-Ray and CT, MRI, often with bone destruction, lumbar large muscle abscess, systemic toxicity symptoms. Differentiate with lumbago with sciatica disease 1.Neurogenoma and cauda equina tumor: clinical manifestations are similar, nerve tumor is found slowly, progressive damage, no history of trauma-induced.X-ray: vertebral root distance and intervertebral foramen are enlarged. Spinal myelography, CT, MRI, cerebrospinal fluid examination can be mainly differentiated. 2.Spinal stenosis signs: intermittent claudication is the main cause, with many complaints and few physical signs. Intermittent claudication and auxiliary examination. Differ with sciatica as the main manifestation of the disease 1, pyriformis syndrome: gluteal and lower extremity pain as the manifestation: rest can be relieved, gluteal atrophy is seen, gluteal deep pressure pain. Striae can be palpated, no nerve localization signs. Piriformis muscle tension test (+), “4” resistance (+). 2.Pelvic diseases: inflammatory tumors of the posterior pelvic wall, atypical persons should undergo pelvic gynecological examination. Treatment: (i) Conservative treatment: purpose: to make the inflammatory edema of the nerve root subside faster and reduce the irritation or compression of the nerve root, indications: young first attack, those with a short course of the disease, and those whose symptoms can be relieved after rest. Those without X-Ray spinal stenosis, those without normal treatment within six months, those without cauda equina symptoms, and those without nucleus pulposus detachment. 1, absolute bed rest: accounted for 50 of the treatment, and even some patients can be cured without treatment, three weeks or four weeks later, the lumbar girdle to protect the activities out of bed, and do not do bending activities within three months. 2, continuous traction or intermittent traction: can expand the intervertebral space, reduce the internal pressure of the disc, and even negative pressure to play the role of inward attraction. Additionally, the vitality of the longitudinal ligament increases, which can compress part of the nucleus pulposus to return. Reduce the irritation of the nerve root, block the vicious cycle, 7-15Kg. can be pelvis and upper trunk against traction, can also be feet, head of the bed, the body against hanging traction, intermittent day two, 1-2 hours / times. The free type of nucleus pulposus is not suitable for traction, and those who cannot tolerate it are not suitable for traction. 3.Physiotherapy, massage, massage, Chinese medicine Chinese medicine. 4, hormone application: hard external closure. Dimetry 10mg 654-2 needle 10mg VB1 100mg Lidocaine needle 0,1g Vb12 500mg physiological saline 20ml extradural injection 5, nucleus pulposus chemical local melting method: collagenase injected into the intercalated disc, the use of enzyme selective dissolution of the nucleus pulposus and the annulus fibrosus, with allergic phenomenon of local irritation signs or re-adhesion. (ii), 1, percutaneous nucleotomy: through the discoscope under X-Ray fluoroscopy, direct access to the intervertebral disc, the nucleus pulposus suction, mainly used for bulging or mild herniation, accompanied by lateral saphenous fossa stenosis can not be used. 2.Ultra-low temperature vaporization: use ultra-low temperature device to make the nucleus pulposus directly vaporized and sucked out through the luminal instrument, the same as 6. (iii) Surgical treatment: if the diagnosis is obvious, strict conservative treatment for more than a few years or cauda equina compression, nucleus pulposus removal is appropriate. Lifelong lumbar back extension exercise. Prevention: Jiangsu Provincial Hospital of Traditional Chinese Medicine Orthopedics Dr. Yan Peijun said: for lumbar disc herniation, focus on prevention. So, how to prevent lumbar disc herniation or prevent its recurrence? Pay attention to the usual posture of standing, sitting, labor posture and sleeping posture of the reasonableness, correct the bad posture and habits, strengthen the exercise, strengthen the physical fitness, especially strengthen the lumbar back muscle function exercise, because appropriate exercise can improve muscle blood circulation, promote metabolism, increase muscle responsiveness and strength, loosening the adhesion of the soft tissues, correcting the spinal column internal balance and external balance of the imbalance, and improve the lumbar vertebrae stability, flexibility and durability, so as to achieve the lumbar vertebrae stability, Flexibility and durability of the lumbar spine, so as to achieve a good therapeutic and preventive effect. And in the cold and wet season should pay attention to keep warm to prevent the recurrence of this disease.