Low back pain is a common and prevalent clinical condition and an internationally prevalent disease. It is the occupational disease with the highest incidence, and herniated discs cause enormous social expense and loss of labor and are of worldwide concern. It is estimated that 75-85% of people will develop low back pain during their lifetime. First, I have no lumbar spine trauma, how did I get lumbar disc herniation In the clinic, there are often patients who say, “I am so young, never had any trauma, how did I get lumbar disc herniation? To understand these questions, it is important to understand the pathogenesis of lumbar disc herniation. The causes of lumbar disc herniation are internal and external. The internal causes are mainly degenerative changes in the lumbar spine; the external causes are trauma, strain or overwork, cold and moisture, etc. 1, degenerative changes in the intervertebral disc: the lack of blood supply to the intervertebral disc, the repair energy is weak, the daily life of the intervertebral disc by all sides of the extrusion, pulling and twisting effect, easy to make the intervertebral disc nucleus pulposus, fibrous ring, cartilage plate gradually aging, resulting in the fibrous ring easy to rupture, and cause the disc protrusion. 2, long-term vibration: car and tractor drivers in the driving process, long-term sitting and bumpy state, the lumbar intervertebral disc under excessive pressure, can lead to disc degeneration and protrusion. At the same time vibration also affects the intervertebral disc nutrition, the impact on the microvascular can accelerate the disc protrusion. 3, excessive load: when the lumbar load is too heavy, long-term bending work, such as: coal miners or construction workers, need to bend over for a long time to pick up heavy objects, lumbar intervertebral disc load more than 100 kPa / cm2, that led to rupture of the intervertebral disc fiber ring. 4, trauma: because the lumbar spine is arranged in a physiological convexity, the intervertebral disc is thick and thin, when the patient in the lumbar injury, bruises, flash back, etc., the intervertebral disc nucleus pulposus moves backward, and the disc protrudes backward. 5, lumbar penetration: lumbar penetration after the narrowing of the intervertebral space and disc protrusion. 6, other causes: (1) age: the incidence of disc protrusion 20-40 years old accounted for 64.46%, more than 40 years old accounted for 34.92%, the average age of 40.8 years. (2) Height: Men and women who exceed the normal average height. (3) Genetics: This is also a considered aspect of etiology. (4) Pregnancy: the entire ligament system is in a relaxed state during pregnancy, and the posterior longitudinal ligament is susceptible to disc bulge on the basis of relaxation and degeneration, with an increased incidence of multiple pregnancies. (5) Smoking: the alteration of blood flow by smoking has been reported. (6) diabetes mellitus: often leads to increased atherosclerosis, easily causing blood circulation disorders. I often have back pain, how to prevent lumbar disc herniation? Due to the accelerated pace of modern life and work, the burden on the lumbar region inevitably increases, due to factors such as occupation or daily life, may lead to acute and chronic injury to the lumbar muscles and intervertebral discs. Low back pain is an early sign of cumulative damage to the lumbar region, and about 35% of people with long-term chronic low back pain can eventually develop lumbar disc herniation. However, paying attention to lumbar health care in daily life and work, to prevent the occurrence of acute and chronic low back pain, can often receive twice the effect with half the effort. Strengthening the muscles of the low back helps maintain the stability of the lumbar region. It can effectively prevent the occurrence of acute and chronic lumbar injuries and low back pain. This is especially important for patients who have had acute and chronic lumbar muscle injuries or lumbar disc herniation and are currently in remission. The method of lumbar back exercise is easy and inexpensive, and can be done by everyone on a daily basis. Exercise can be prone on the bed, go to the pillow, hands behind the back, force the chest to lift the head, so that the head and chest leave the bed, while the knee joint straight, two thighs force backward also leave the bed, for 3 to 5 seconds, and then muscle relaxation rest 3 to 5 seconds for a cycle, this method is commonly known as “swallow fly” or “small swallow fly “; for the lumbar muscle strength is weak or obese people, the above method is more laborious, you can use the following method of exercise, lying on your back in bed, go to the pillow bending knees, lifting the hips for 3 to 5 seconds, and then muscle relaxation, put down the hips to rest for 3 to 5 seconds for a cycle. You can choose the method that suits you to exercise according to your actual situation. In addition, cold and humidity can stimulate muscle spasm and induce lumbago, which can trigger or aggravate the symptoms of lumbar disc herniation. Therefore, attention should be paid to keeping the lumbar area warm, and at the same time, attention should be paid to avoid catching a cold and getting cold; in cold and humid environments, more attention should be paid to preventing sprains of the lumbar muscles; when working in cold and humid conditions, more attention should be paid to the rest and working posture of the lumbar area to prevent overexertion and to minimize the time spent working with the head down for a long time in cold and humid conditions to prevent the appearance of symptoms of lumbar disease or induce lumbar back pain. symptoms; sleep at night to keep warm and pay attention to sleeping posture. Third, the imaging report of lumbar disc herniation, what should I do? In clinical practice, when some patients take CT or MR of the lumbar spine for various reasons, the radiology report will sometimes say “lumbar disc herniation”. There are many causes of disc herniation, including degeneration and aging of the cervical or lumbar spine, followed by protrusion of the disc into the spinal canal, formation of bone spurs on the posterior edge of the vertebral body, hypertrophy of the ligamentum flavum, and hyperplasia of the synovial joint. Other causes of disc herniation include strain and trauma. A herniated disc can compress the spinal cord or nerve roots in the corresponding area, resulting in symptoms such as numbness, weakness, pain or even paralysis of the limbs and dysfunction of urination and defecation. However, degenerative disc herniation has a slow process of development. Generally speaking, after the age of 25 to 30, the human spinal discs and intervertebral joints can begin to show signs of aging such as degeneration and proliferation. Many people have herniated discs in the cervical or lumbar spine, but until they die, they do not have the corresponding symptoms of compression of the spinal nerve roots, and even if they do, most of them do not start to show the corresponding symptoms until after they are 40 or 50 years old. When radiologists issue radiology reports based on their radiographs, they will faithfully write down the degenerative growth of the cervical or lumbar spine, herniated discs, and other manifestations. However, these imaging manifestations of degenerative hyperplasia and disc herniation in the cervical or lumbar spine have no clinical significance because there are no corresponding clinical symptoms, so there is no need for orthopedic surgeons to deal with them, and patients do not need to make a fuss. Fourth, how to choose which treatment – the ladder treatment of the intervertebral disc There are many treatments for herniated discs, how do I choose the most suitable treatment for myself? The domestic treatment for herniated discs is either conservative or disc treatment plus fusion therapy. With the advancement of medicine, modern medicine has developed non-fusion techniques, minimally invasive techniques, etc. between conservative and fusion. After arranging these treatments step by step, it can help clinicians to choose the treatment more reasonably and scientifically. The first step: conservative treatment Conservative treatment is the preferred treatment method. Through regular conservative treatment, 80% of patients can have their symptoms relieved or even cured. Patients who do not require emergency surgery can be treated conservatively. Conservative treatment includes bed rest, bracing, physiotherapy, physical therapy, traction, and oral pain medication or muscle relaxants. Second Stage: Interventional Treatment Interventional treatment of herniated discs includes physical, chemical, and mechanical. For example, intervertebral disc excision and suction, ozone nucleus oxidation, drug chemical nucleolysis, radiofrequency ablation, laser ablation, plasma ablation, etc. Although they seem to be diverse, they share the common feature of reducing the volume of the nucleus pulposus of the intervertebral disc through various methods, thereby reducing the internal pressure of the diseased disc, retracting the herniated lumbar disc, relieving its compression on the nerve root, eliminating or reducing the inflammatory response, so that The symptoms can be eliminated or reduced to achieve the purpose of treatment. Minimally invasive treatment should be further considered for patients who are not suitable for interventional treatment. At present, the main minimally invasive procedures for the lumbar spine are discoscopy and intervertebral foraminoscopy. The former is done through a posterior lateral approach; the latter through a posterior lateral approach. The indications for minimally invasive surgery are almost identical to those for traditional hemilaminectomy, laminectomy, and disc nucleus pulposus removal. All minimally invasive techniques are selected in patients who have indications for conventional incisional surgery. The indications are mild to moderate simple inclusive lumbar disc herniation. Fourth Stage: Conventional Surgery When the patient’s condition is too severe to be treated with the aid of the above methods, conventional surgery such as interlaminar openings, hemi-laminectomy, and total laminectomy, including microsurgery or conventional surgery under direct vision, may be considered. Currently, interlaminar opening and discectomy are routinely applied. The fifth step: non-fusion versus fusion techniques Spinal fusion fixation has been the gold standard in the surgical treatment of lumbar instability or lower back pain due to disc degeneration. However, the problems of loss of segmental motion and adjacent segmental degeneration after fusion fixation negatively affect the outcome. Nonfusion fixation is first and foremost a fixation designed to control abnormal intersegmental motion. However, its “non-fusion” nature allows for physiologic intersegmental motion. Non-fusion fixation techniques have strict indications for the treatment of lumbar disc herniation. It is generally considered to be indicated for patients with mild lumbar instability, but not for cases with combined bony deformities, severe spinal stenosis requiring extensive decompression, or severe slippage. Nonfusion interspinous devices are primarily indicated for lumbar spinal stenosis due to structural degeneration of the posterior column and should not be used for simple lumbar disc herniation. There is no follow-up evidence that this technique is superior to fusion fixation techniques. Most scholars agree that there is no difference in clinical outcomes between the two, but the non-fusion technique preserves the motor function of the spine. Fusion fixation surgery is the ultimate treatment for lumbar disc pathology. It is indicated in the presence of both lumbar instability and slippage. Indications are discogenic low back pain, combined lumbar spinal stenosis or lumbar spondylolisthesis, preoperative or postoperative instability of the disc lesion segment, and recurrence of the original segment of lumbar disc herniation. Follow-up data indicate that spinal fusion fixation techniques are safe and effective, and have become the gold standard for the treatment of degenerative spinal diseases and spinal instability, as well as the ultimate remedy for the various treatments described previously. Will lumbar disc herniation surgery result in paralysis Will lumbar disc herniation surgery result in paralysis? Many people suffering from lumbar disc herniation are very afraid that they will be paralyzed if they get this disease, so they worry all day long and are very afraid. Surgery is the most effective, rapid and reliable treatment method. It has become a classical treatment method that is recognized worldwide. In the United States, the first disc nucleus pulposus removal is done in about 300,000 cases every year, but in China, there are less than 60,000 cases, and there are about 120 million patients with disc herniation in China. It even leads to paralysis and no treatment. Or lead a painful life without any quality of life to speak of. Loss of ability to work. What is the reason? The reason is simple: almost all people believe that it is easy to be paralyzed by surgery on the lumbar spine. Is lumbar spine surgery really that terrible? The following aspects of the analysis can help you solve the mystery: 1, the nerve is not as thick as a hair as you think, the nerve of the lumbar spine is roughly equivalent to the thickness of an infusion tube, the diameter is about 0.3- 0.5 cm. 2, perfect operating routine, meticulous precautions, the possibility of nerve damage in the lumbar spine is already very low, about 0.1-0.2%. 3.The nerve roots in the lower lumbar spine have a cross-distribution function, and even if a nerve is injured, other nerves can often replace its function without easily paralyzing it. 4.Experienced specialist doctors, special and sophisticated surgical equipment, anatomical relationship known to medicine. Advanced examination and diagnosis technology. The seemingly reasonable advice that “surgery is prone to paralysis” is old hat. 5. New treatment techniques can remove herniated disc tissue using mechanical, chemical or physical energy methods under the monitoring of high-tech achievements. This makes it less damaging and safer. For example, the emergence of posterior disc systems, discotomy and suction techniques, ozone technology, laser decompression, etc. Therefore, the simple fear that surgery may be paralyzing is obviously not much justified. On the contrary, delaying the condition due to a single-minded fear without regard to the specificity of the condition will not only paralyze, but also make it difficult for the treatment to have the desired effect. Such lessons are common in clinical work.