Lumbar intervertebral disc herniation: a disease with lumbar pain as the main manifestation due to nerve root compression by herniated nucleus pulposus after rupture of the fibrous ring. I. Etiology: 1. Degenerative changes: At present, it is believed that the basic etiology is degenerative changes of the lumbar intervertebral disc (which can be interpreted as aging). Because of the special physiological function of the lumbar spine, the degeneration of the lumbar disc is earlier than other tissues and organs, and the progress is relatively fast. That is, because the disc is compressed by the weight of the vertebrae, and the lumbar region is often flexed and extended, it is easy to cause extrusion and wear of the discs, especially the discs in the lower back, thus producing degenerative changes. Degenerative changes in the lumbar intervertebral disc is the basis for the occurrence of this disease. 2, other factors (1) the role of external forces: in daily life and work, some people tend to have long-term lumbar improper force, excessive force posture or incorrect body position, etc.. Long-term repeated damage caused by external forces act on the intervertebral disc over time, increasing the degree of degeneration. (2) Weakness of the disc’s own anatomical factors: ① The disc gradually lacks blood circulation after adulthood. The repair capacity is also poor, especially after degeneration has occurred, and the repair capacity is even weaker. ②The posterior lateral fibrous ring of the disc is weaker, and the width is significantly reduced in the lumbar 5 and sacral 1 planes, and the strengthening effect on the fibrous ring is significantly weakened. ③ congenital abnormalities of the lumbosacral segment: deformities of the lumbosacral segment can increase the incidence, and these abnormalities often cause unequal width of the vertebral space, and often cause more rotational strain on the synovial joints, so that the fibrous ring is subjected to varying pressure and accelerates degeneration. 3, race, genetic factors: people of color have a lower incidence; for example, Indians and black Africans have a significantly lower incidence than other ethnic groups. 4, common predisposing factors: (1) increased abdominal pressure, such as violent coughing, constipation when forceful defecation, etc. (2) Improper lumbar posture, when the waist is in a flexed position, such as the sudden rotation is easy to trigger the nucleus pulposus protrusion. (3) Sudden weight-bearing, when not fully prepared, sudden increase in lumbar load may cause herniation of the nucleus pulposus. (4) Lumbar trauma, acute trauma can affect the fibular ring, cartilage plate and other structures, and promote the protrusion of degenerated nucleus pulposus. (5) Occupational factors, such as car drivers in a sitting position and bumpy state for a long time, prone to induce disc protrusion. Second, clinical manifestations: 1, low back pain low back pain is the first symptom of most patients with this disease, the incidence of about 91%. A few patients only have leg pain without lumbar pain, so that not every patient will necessarily occur lumbar pain. There are also some patients who have low back pain first and then leg pain after a period of time, while the low back pain reduces or disappears on its own, and when they come to the clinic, they only complain of leg pain. The pain is mostly tingling, often accompanied by numbness, soreness and swelling. 2, lower limb radiating pain lumbago is easy to attack after trauma, exertion and cold, and the pain is often relieved if you rest in bed during the attack. Those who engage in heavy physical labor, especially those who repeatedly bend over, have a high chance of having low back pain. Any factors that increase abdominal pressure, such as coughing, forceful defecation, laughing, sneezing, lifting heavy objects, chronic coughing, etc., are likely to trigger low back pain or aggravate the already occurring low back pain. 3.Lumbar activity is limited if the fibrous ring is not completely ruptured, the lumbar spine takes the forward flexion position and the back extension is limited. The reason for this is that when the lumbar spine is flexed forward, the ligamentum flavum between the vertebral plates is tense, increasing the volume of the spinal canal and the posterior space of the intervertebral space, and the corresponding increase in tension of the posterior longitudinal ligament makes the protruding nucleus pulposus partially return, thus reducing the symptoms of nerve root compression. 4, scoliosis This is a postural compensatory deformity adopted by patients with lumbar disc herniation to reduce pain. 5, claudication lumbar disc herniation occurrence of claudication is mostly intermittent, that is, walking a distance after the pain of the lower limbs, weakness, bending or squatting to rest after the symptoms can be relieved, still can continue to walk. 6, sensory numbness in patients with lumbar disc herniation, some of them will not appear pain in the lower limbs, but only numbness in the limbs, which is mostly caused by the compression of the nerve proprioceptive and tactile fibers by the intervertebral disc tissue. The density of the nucleus pulposus, fibrous ring and cartilage plate included in the lumbar intervertebral disc is low and does not show up under X-ray, so clinically the lumbar spine X-ray plain film of patients with lumbar herniation can have only some non-specific changes or even no abnormal changes. 2.CT examination CT of the lumbar spine can clearly show the site, size, morphology and nerve root and dural compression of the herniated disc, as well as the hypertrophy of the ligamentum flavum, small joint hyperplasia, narrowing of the spinal canal and lateral saphenous fossa, etc. 3, MRI MRI has no radiation, can be multi-directional imaging (cross-sectional, coronal, sagittal and oblique), shows better anatomical details, is more sensitive to subtle pathological changes in tissue structures (such as infiltration of bone marrow), and can exclude nerve and spinal tumors, etc. Some nucleus pulposus tissue that falls into the spinal canal is also not missed. It is currently the most powerful diagnostic modality to confirm the diagnosis of lumbar disc herniation. Non-surgical treatment Non-surgical treatment is the basic treatment for lumbar disc herniation, and more than 80% of patients can be relieved and cured by conservative treatment. The main therapies are: (1) bed rest; (2) traction therapy; (3) massage therapy; (4) physical therapy; (5) anti-inflammatory and analgesic drugs, mainly: Loxone, Fotalin, etc. These drugs are suitable for most patients, but a few patients have gastrointestinal reactions and other side effects, such as nausea, vomiting, stomach pain, diarrhea, etc. Patients with peptic ulcers are cautiously used or prohibited; (6) reduce The application of nerve root edema drugs, such as mannitol, hormones, etc., the anti-inflammatory and analgesic effect of these drugs is very prominent, especially in the acute phase of lumbar disc herniation, but mannitol is used with caution for people with renal insufficiency, and hormones are prone to rebound symptoms when the drug is stopped. 2.Surgical treatment The traditional disc removal methods are open window method, half laminectomy and full laminectomy. The opening method has less soft tissue separation, limited bone removal, and less impact on spinal stability, so most disc herniations can be treated with this method. In addition to traditional disc removal, intervertebral discoscopic removal, but this type of surgery has strict indications and is not suitable for all patients, requiring an orthopedic specialist to determine the surgical approach.