Basic overview Lumbar disc herniation is one of the more common lumbar disorders in clinical practice and is a common and frequent disease in orthopaedics and traumatology. The lumbar disc exists between the vertebrae of the lumbar spine, which is equivalent to a micro-movement joint, and is composed of a transparent cartilage plate, a fibrous ring and the nucleus pulposus, which is distributed among the lumbar vertebrae and is a component of the lumbar vertebral joint, playing the role of support, connection and buffer for the lumbar vertebrae, and is shaped like a flattened abacus bead, consisting of the nucleus pulposus, cartilage plate and fibrous ring. When the nucleus pulposus is prolapsed due to posterior convexity or fracture of the fibrous ring caused by trauma or degeneration, it is called lumbar disc herniation. Since the spinal cord passes behind the intervertebral disc, when the herniated disc presses on the spinal nerve or cauda equina nerve, causing back and leg pain or incontinence, or even paralysis, it is called lumbar disc herniation. The disc is located between two adjacent vertebral bodies and is composed of two parts: the outer part is the fibrous ring, which consists of multiple layers of fibrocartilage rings arranged in an annular pattern around the nucleus pulposus, preventing the nucleus pulposus from protruding outward, and the inner part is the nucleus pulposus, which is an elastic gelatinous substance that has the effect of moderating impact. In adults, the intervertebral disc undergoes degenerative changes, the fibers in the annulus fibrosus become thicker, glass degeneration occurs and finally rupture, so that the disc loses its original elasticity and cannot bear the original pressure. Under overstrain, sudden change in position, violent action or violent impact, the annulus fibrosus can expand outward, so that the nucleus pulposus can also protrude outward through the fissure of the ruptured annulus fibrosus, which is called disc herniation. Lumbar disc herniation can be divided into: 1, lumbar disc bulge: that is, the fibrous ring is not completely ruptured, the nucleus pulposus protrudes from the breakage to compress the nerve root. 2, lumbar disc herniation: the fibrous ring is ruptured and the nucleus pulposus is extruded from the rupture, compressing the nerve root. 3, lumbar disc prolapse: the fibrous ring ruptures, the nucleus pulposus extrudes from the rupture, breaks through the posterior longitudinal ligament, frees into the spinal canal, and compresses the nerve root spinal cord. (1) In terms of age, lumbar disc herniation occurs in young and middle-aged people. (2) In terms of gender: lumbar disc herniation is mostly seen in men, the incidence of men is higher than that of women, and the ratio of men to women is generally considered to be 7:3. (3) In terms of body type: people who are generally too obese or too thin are prone to lumbar disc herniation. (4) Occupationally: Industrial workers with high labor intensity are more common, but the incidence rate of brain workers is not very low at present. (5) From the posture point of view: poor work posture row ambulatory staff, and often standing salesman textile workers are more common. (6) from the living and working environment: often in the cold or humid environment have become a certain degree of induced lumbar disc herniation conditions. (7) In terms of different periods of women: prenatal and postnatal period and menopause are the risk periods for lumbar disc herniation in women. (8) People with congenital lumbar spine dysplasia or deformity, or even people who are too mentally stressed are prone to suffer from lumbar pain smoking, which may be related to the fact that coughing causes an increase in the internal pressure of the intervertebral disc and the pressure in the spinal canal, making it easy for degenerative changes to occur. Clinical manifestations (1) Low back pain Most patients have a history of low back pain for several weeks or months, or a history of recurrent episodes of low back pain. The degree of low back pain varies, and severe cases may affect turning and sitting. Generally, the symptoms are relieved after rest, but coughing, sneezing or straining during bowel movement can aggravate the pain. (2) Radiating pain in the lower extremity The radiating pain in the sciatic nerve area of one side of the lower extremity is the main symptom of the disease, which often appears when the low back pain disappears or is alleviated. The pain starts from the buttock and gradually radiates to the posterior thigh and lateral calf, and some may develop to the lateral dorsum of the foot, heel or palm of the foot, affecting standing and walking. If the prominence is in the center, the symptoms are in the cauda equina nerve, and if the prominence is bilateral, the radiation may be bilateral or alternating. (3) Lumbar movement disorders are affected in all aspects of lumbar movement, especially posterior extension disorders. In a few patients, it is significantly limited in forward flexion. (4) Scoliosis Most patients have varying degrees of lumbar scoliosis. The direction of scoliosis can indicate the relationship between the location of the protrusion and the nerve root. (5) Observation of numbness: those with longer duration of disease often have subjective numbness. It is mostly limited to the posterior lateral calf, dorsum of the foot, heel or palm of the foot. (6) The temperature of the affected limb decreases. Many patients have a cold sensation in the affected limb, and on objective examination, the temperature of the affected limb is lower than that of the healthy side; in some cases, the arterial pulsation of the dorsalis pedis is also weaker, which is due to the stimulation of sympathetic nerves. It must be distinguished from embolic arteritis.