How herniated discs should be treated

  Cervical and lumbar disc herniation is a common and frequent disease, and is the most common cause of neck, shoulder and lumbar pain.  The clinical manifestations of cervical disc herniation are neck stiffness and discomfort or neck and back pain, unilateral upper limb and finger radiating pain or numbness, hand numbness and weakness, bilateral lower limbs weakness, walking weakness like stepping on cotton, dizziness and tinnitus, migraine, eye swelling, panic, nausea, vomiting, etc. The main manifestations of lumbar disc herniation are pain in the lumbosacral region, buttocks and lower limbs, claudication, lower limb numbness and limb atrophy, and in severe cases, restriction of activities or abnormal sensation in the perineum.  Herniated disc is a common disease in middle-aged and old people, with characteristics such as increasing incidence, diversified symptom expression, disproportionate size of herniation and symptoms, low rate of surgical treatment, large proportion of rupture of the fibrous ring and little simple bulge.  The choice of treatment for disc herniation depends on the different pathological stages and clinical manifestations of the disease, the patient’s physical, psychological and economic conditions. It is mainly divided into non-surgical treatment, minimally invasive treatment and surgical treatment.  Non-surgical treatment is suitable for those who cannot perform surgical treatment because of the initial onset, short duration of the disease, mild symptoms and signs, small disc herniation on imaging or old age and frailty, systemic diseases or local skin diseases. Commonly used methods include bed rest, medication, traction therapy, physical therapy, massage, acupuncture, closure, acupuncture and knife therapy.  Surgical treatment is suitable for those who have a history of more than six months, conservative treatment is ineffective, symptoms are aggravated, imaging examination shows large nucleus pulposus protrusion or free into the spinal canal, accompanied by obvious ligamentum flavum hypertrophy or bony spinal canal stenosis, intraforaminal or extreme lateral type lumbar disc protrusion. The surgical methods include laminectomy and decompression, hemi/total laminectomy, unilateral laminectomy and arthroplasty, foraminotomy, ligamentum flavum resection, spinal endoscopic microdiscectomy, artificial disc replacement, artificial nucleus pulposus implantation, and spinal/lumbar fusion.  Interventional treatment is one of the main treatments for cervical and lumbar disc herniation, including minimally invasive interventions such as percutaneous puncture disc nucleotomy and aspiration, laser nucleus pulposus decompression, collagenase lysis, low-temperature plasma radiofrequency nucleoplasty and ozone nucleolysis. It is suitable for those who have not been treated with strict non-surgical conservative treatment for more than 2-4 weeks or have recurrence, whose main symptoms are neck and shoulder pain, arm pain or sciatica, or lower back pain, who have corresponding signs on neurological examination, who have a clear diagnosis of disc herniation on imaging examination, whose lesion site and direction of protrusion are compatible with the pain symptoms, and who are physically capable of receiving minimally invasive treatment by percutaneous puncture intervention.  Interventional treatment of disc herniation is performed by placing the puncture needle in the disc or in the epidural space of the corresponding intervertebral space under television fluoroscopy, and then selectively introducing a fibrous ring cutter and nucleus pulposus for disc nucleotomy, or laser fiber for laser nucleus pulposus decompression, or radiofrequency head for low-temperature plasma radiofrequency nucleoplasty, or injecting ozone gas into the disc for ozonolysis. Ozone gas is injected into the intervertebral disc for ozonolysis, or diluted collagenase is injected into the epidural space for collagenolysis, or a combination of interventional techniques in the same channel is used according to the extent of the lesion and the severity of the symptoms.  The mechanism of interventional treatment is similar to that of surgery, including reducing the intradiscal pressure, changing the direction of the herniated nucleus pulposus, promoting the retraction of the herniated fibrous ring and nucleus pulposus, reducing the irritation of the nerve root by the disc tissue, and relieving the compression of the nerve root by the herniated material. Routinely used hormonal drugs and targeted injections of ozone and collagenase also have anti-inflammatory, reducing nerve root water, adhesions and analgesic effects.  Compared with traditional treatment methods, interventional treatment of disc herniation has the advantages of small trauma (one injection is sufficient), fast results (at the time or several days after surgery), short hospitalization (about 1 week for outpatient treatment or hospitalization), few complications (almost none), high efficacy (the efficiency is about 90%), and low cost.  Disc intervention combined with conservative treatment, postoperative rehabilitation and local functional exercise can further improve the efficacy and shorten the course of treatment and reduce the frequency and degree of recurrence of lesions.