Central lumbar disc herniation is generally an indication for surgery and is a difficult condition. Thanks to the application of small needles and the design of a special repositioning technique, this disease can also be treated without surgery. It is safe and reliable, with no complications or sequelae. Anatomy The lumbar intervertebral disc and its associated anatomy are extremely complex. The spine is the central pillar of the human body and consists of 26 vertebrae (7 cervical, 12 thoracic, 5 lumbar and 1 sacrococcygeal) connected by 23 intervertebral discs, intervertebral joints and several ligaments in adults. These tissues form the spinal canal and intervertebral foramen. The spinal canal houses the spinal cord and nerve roots, and the intervertebral foramen passes through the nerve roots and root arteries and other tissues. There is intervertebral disc tissue between the two vertebral bodies of the spine, and two adjacent vertebrae form a functional unit. The vertebral bodies and intervertebral discs have an anterior longitudinal ligament in front and a posterior longitudinal ligament in back. The posterior part of the vertebral body has a vertebral plate and small joints connected by the ligamentum flavum and the joint capsule, as well as the interspinous ligament, supraspinous ligament and intertransverse process ligament and related muscles to form a more stable lumbar spine. The anterior longitudinal ligament is located in front of the vertebral body, starting from the bottom of the occipital bone and the posterior atlantoaxial node, and ending at the upper part of the sacrum, and its morphology is narrow and thick in the thorax and wide and thin in the cervical and lumbar regions. The anterior longitudinal ligament is closely connected to the anterior edge of the vertebral body and intervertebral disc, and has the function of limiting spinal hyperextension. Tearing of the anterior longitudinal ligament due to hyperextension trauma is very common, and there may be anterior disc prolapse, causing low back pain. The posterior longitudinal ligament is located in the posterior part of the vertebral body, starting from the pivot and continuing with the overlying membrane and reaching the anterior wall of the sacral canal, narrower than the anterior longitudinal ligament, and cannot completely cover the back of the vertebral body and the intervertebral disc. It is also weak on both sides. The ligament is closely connected to the upper and lower vertebral body, but there is a gap between the ligament and the vertebral body, through which the venous plexus passes. The discs often protrude from the side. Ossification of the posterior longitudinal ligament, which is common in the cervical and lumbar spine, is one of the major causes of spinal cord compression. The pressure within the L3-4 intervertebral disc, measured in the standing position, can be reduced by 50-60 in the supine position; if in an unsupported sitting position it is increased by 40%; when bending at 40°, it is increased by 100%; if bending forward plus rotation it is increased by 400%. Such as forward bending lifting 2Kg of heavy objects, the pressure in the intervertebral disc can reach 10 times the pressure in the prone position. Therefore, it is believed that frequent or sudden forward bending and rotation is the main cause of lumbar disc herniation. Etiology The majority of central lumbar disc herniations occur in the L5 and S1 intervertebral discs, and very few occur in the L4 and 5 intervertebral discs, while they do not occur in other lumbar intervertebral discs. The causes are closely related to the following factors. First, the posterior longitudinal ligament on the posterior side of the fifth lumbar intervertebral disc is weak and narrow, and this is the place where the disc is most likely to protrude. Second, with age and frequent flexion and extension of the spine or bending and turning, the water and nutrients in the lumbar intervertebral disc decrease, so the elasticity decreases significantly. Due to the increase of collagen fibers, the intervertebral disc gradually becomes narrower, making its surrounding ligaments loose and generating excessive activity between vertebrae, together with the operation of biochemical factors of the intervertebral disc, etc., which becomes the intrinsic basis for the protrusion of the lumbar intervertebral disc from the center. On this basis, when the lumbar region is affected by sprains of forward flexion or weight bearing bending, etc., it leads to rupture of the fibrous ring and prolapse of the nucleus pulposus to the positive posterior side, compressing the nerve roots and spinal cord on both sides, causing pain and numbness of both lower limbs or saddle-like paralysis. Clinical manifestations and diagnosis 1, young adults with a history of lumbar sprain or cumulative injury. 2.Lumbar and leg pain with bilateral symmetrical sciatic nerve trunk pain. It is aggravated when walking and standing and relieved when lying in bed, sometimes light and sometimes heavy, but can ride a bicycle. 3.Low back stiffness and restricted movement, walking in a duck walk. 4. Deep pressure pain with radiating pain on both sides of the spinous process of the lower back, generally light on one side with one focus. 5. Bilateral positive sciatic nerve pull test (i.e. positive branch leg elevation and strengthening test), abnormal sensory disturbance and reflexes in the corresponding area of L5-S1 nerve branch. Some of them have saddle palsy and loss of urine and stool. 6.X-ray examination and CT examination, refer to lumbar disc herniation. 7.Except lumbar spine tuberculosis, tumor and other diseases. Acupuncture treatment 1.Position: prone position. 2.Body surface markings: two iliac spine lines through the L4 spine or L4.5 interspinous. 3.Setting points: ①②L5-S1 or L4-5 interspinous and a total of three points between the transverse processes on both sides. It can also be fixed after the pelvic traction. The traction force should be tolerated by the patient and should not be too large (about 30Kg). ③ other soft tissue injury points (lumbar, hip, leg pressure pain points) 4, routine skin disinfection, wearing gloves, laying sterile towel, perform needle knife surgery. 5, needle knife operation: ① in the interspinous point into the needle knife. The incision line is parallel to the longitudinal axis of the spine, stabbed vertically on the skin surface, over the tip of the spinous process, enter the interspinous process, turn the incision 90 degrees, and perform incision and peeling at the upper edge of the spinous process. ② Enter the needle knife at the point of the transverse interspinous process. The incision line is parallel to the longitudinal axis of the spine, and the needle blade body is stabbed perpendicular to the skin surface. The transverse process is first reached, and the blade is moved to the lower transverse process edge, and the incision line is rotated 90 degrees, parallel to the lower transverse process edge, and the incision is performed close to the bone surface of the lower transverse process edge to release the intertransverse process ligament and intertransverse process muscle. The contralateral intertransverse process was treated similarly. (3) For other lumbar, hip and leg soft tissue injury pressure points, the needle knife treatment is the same as that for the corresponding soft tissue injury. After surgery, sterile excipients cover the needle knife mouth, fixed. 6.Manipulation operation: after needle knife release, perform manual repositioning. Let the patient lie prone on the treatment table, first pelvic traction, traction force between 40-120Kg (than the needle knife treatment traction force to be larger), for 20 minutes. Then do continuous leg lifting and repositioning to make it reset. 7. Drug treatment: ① Give drugs to eliminate edema. Such as 20% mannitol 250ml, intravenous drip, ensure that the drip is finished within half an hour, 1-2 times a day for three days. ②Give drugs to activate blood circulation and remove blood stasis, such as compound salvia injection intravenously (added to 5% glucose or 0.9% sodium chloride liquid). Once a day for one week. ③Give antibiotics appropriately. ④Give the herbal medicine to open the meridians and activate the collaterals, Luluo No. 1 Punch, 1 packet, twice a day, with plain water. ⑤ If there is abdominal distension and constipation, give senna leaves in water to drink. Care and rehabilitation exercises 1. Overall lifting and overall turning with the patient absolutely bedridden. At the end of the manipulation, the patient is transported back to the ward according to the method of transporting patients with spinal trauma. Keep the patient’s torso straight and supine on the hospital bed during transport. The lower extremities can be extended and flexed, but the trunk should not be moved at will, let alone sitting up. Turning over in bed is allowed, but the body must be kept straight and the waist must not be twisted. When urinating and defecating, you must not go down to the ground, and keep the lumbar anterior convex position, and lift the hip with foot support to receive the urine and feces, and need to be absolutely bedridden for three weeks. 2.After the acupuncture treatment, the patient’s body temperature, blood pressure, pulse, respiration and other vital signs should be closely observed, and the sensation and movement of the limbs should be checked frequently, and the changes should be detected, reported and dealt with in time. 3.Pelvic traction. After real knife surgery, do pelvic traction every day, the weight of 1/7-1/10. 2 hours each time, 3-4 times a day, in traction must ensure the traction effect. 4, to the physical wasting patients, pay attention to skin care, to avoid pressure injury skin, to prevent the occurrence of pressure sores. 5, two weeks after acupuncture treatment, feasible flying swallow practice, progressively, 50-100 times a day, and do lower limb lifting exercise, 50-100 times a day each for both lower limbs. 6.After three weeks of absolute bed rest, you can get off the crutches, and after a few days of practice, you can abandon the crutches and walk. 7.No long-distance walking within three months and no heavy physical work within six months. Caution 1. For interspinous point surgery, the needle knife should not pierce into the spinal cord cavity to prevent damage to the cauda equina. 2, the transverse process between the operation, as far as possible in the lower edge of the transverse process, so as not to damage the posterior branch of the spinal nerve, and not to leave the transverse process bone surface, so as not to damage the abdominal organs. 3.When doing the manipulation, the force should be soft and appropriate. Avoid excessive force, too much, in order to reduce the interference with the abdominal organs.