Disease prevention and treatment are two sides, one side is the doctor and the other side is the patient. Before the onset of the disease, we should prevent the onset of the disease, after the onset of the disease to overcome the disease with the help of the doctor, we collaborate to deal with the lumbar protrusion that causes us trouble. First of all, the doctor said, “Zhi in the Road, according to the virtue, according to the benevolence, travel in the arts” For the sudden friend, to “on the work of treating the disease” “strategic contempt for the enemy, tactical attention to the enemy” to the To give everyone a boost: no matter how serious lumbar synostosis is, there is nothing to be afraid of. To put it bluntly, “can not die”, it is not a tumor. At most, the treatment process is long, the treatment effect is poor, the recovery time is long, the recurrence time is short. Lumbar protrusion will always have the day of recovery, so think we deal with this stubborn disease is not much more optimistic? The human body is biological, people are social. The human body is biological, people are social. People are material, but the treatment of people can not be treated as an inanimate object. It is the human being who has non-biological issues such as psychological (emotions, moods, personality) and social background (education, economic conditions, health care affordability) on top of the disease. Medical therapeutic behaviors are complex social behaviors. Every doctor expects his/her patients to recover completely. However, the uncertainty of this behavior is determined based on the medical conditions of the hospital, the level of medical care of the individual, the level of proficiency, the objective conditions at the time of the implementation of the treatment, and so on. The urgent need for more information is the fundamental reason why we have been able to build up our popularity. That’s why: know your enemy and know yourself. This is the smart place of all the sudden friends, this is Sun Tzu’s art of war in the upper strategy, not to fight and give up the army is the upper strategy. The “no war” here refers to conservative treatment. Therefore, conservative treatment is the first choice for all patients. The two most common misconceptions about lumbar synapses are: firstly, refusing invasive treatment, and secondly, demanding complete treatment. The principle of ladder treatment:Follow this ladder: conservative treatment, interventional treatment (ozone, condensation vaporization, laser), minimally invasive treatment (endoscopic surgery, MED surgery, small incision surgery, minimally invasive fusion surgery), open surgery. There are certain indications for any surgery and there is no such thing as an authoritative method. It is not necessary to try them one by one following this ladder for each patient. Under the guidance of an experienced doctor, it is sufficient to choose the most appropriate method according to your condition. The principle of dynamic selection of treatment methods (the principle of riding a donkey to see a singing book) A misunderstanding in the treatment of lumbar protrusion requires a complete cure. Violating the principle of dynamic selection of treatment methods, it is easy to fall into the misunderstanding of over-treatment. Human life is fluid, with different characteristics at different stages. Although fusion is the gold standard for short-term excellent efficacy, choosing the ultimate treatment method too soon is prone to many problems, and this statement is valid for both doctors and patients. An afterthought in choosing a primary treatment method is that of recurrence. Referring to the previous principle, lumbar protrusion is not a tumor and cannot die. Even if it recurs, the doctor still has the right method to give the right treatment. The principle of constant learning and comparison Chinese people have excellent learning habits, as a friend of lumbago, we should continue to learn knowledge related to lumbago, for “one-needle cure”, “lifelong non-recurrence”, “authoritative therapies The “one-needle cure,” “no recurrence for life,” “authoritative treatment,” and so on, all have a clear ability to recognize. In China, it is very easy for smart people to see a doctor. Seeing a doctor is just like buying something, it is best to shop around. Especially before a major decision, do not be confused by a family of words of praise. The principle of minimally invasive treatment with the same efficacy Under the premise of the same efficacy, preferring a more minimally invasive approach is a principle in the treatment of lumbar bulge. The reason why lumbar protrusion is the treatment of choice is because it is very minimally traumatic. Any treatment starting from intervention has the problem of medical trauma, but the risk is just greater or lesser. Even with a very minimally invasive approach such as intervention, I have dealt with many cases of post-interventional infections. There are many more cases of intervention followed by endoscopic treatment. Medical practice is different from business practice. When business practice fails, you lose money that can be earned back. Failure of medical behavior is the loss of irreversible health and pain. Lumbar protrusion, while painful, is much less risky than other diseases. There are diseases where the risk of treatment is the after-effects, the risk of lumbar protrusion is the degree of efficacy, that is, unsatisfactory relief. The patient’s heart is a little more at ease. It is common sense that benefits and risks coexist. Conservative treatment is low risk, low efficacy and high recurrence rate. Open surgery is risky, but also highly effective and has a low recurrence rate. Interventional and minimally invasive approaches fall somewhere in between. Strategies are similar, tactics are different Talk about specific tactical divisions 1. conservative treatment 2. interventional treatment 3. endoscopic surgery 4. MED and fusion surgery 5. small-incision surgery such as mini-TLIF 6. major open surgery such as PLIF My tactical division of labor is within 3-5 items. That is, the early stages of the disease and non-severe cases are not my area of research. It may disappoint you that there is no way around this. There are specialties to be learned, and I can’t do all six of these tasks or I’d be nothing. Below you can suggest specific cases that again show that my academic division of labor is in 3-5 items. I am not a highly skilled physician, because “Sheng Gong cures the unhealthy”. Rehabilitation is not my strong point either, it is the strong point of physical therapy and rehabilitation. My specialty is “Does this disease require surgery? What kind of surgery is needed? What is the expected outcome?” A fellow mutt in the lumbar spine forum said that I’m not the master of fobbing people off on surgery. This is right, although I am a surgeon, but I honor the old adage: body hair and skin, received by parents, do not dare to damage, the beginning of filial piety; people are still original good. All people are afraid of surgery, and even injections, I am the same. But seeing some of my fellow mutants in pain is not comparable to the pain caused by minimally invasive surgery. For patients with severe symptoms and severe imaging changes, it is recommended not to be afraid of surgery, especially not minimally invasive surgery or endoscopic surgery. There is a Chinese saying that a long pain is better than a short pain. Some severe pain can be completely resolved in half an hour. There is no need for long-term conservative treatment. There are serious patients who come to see me after six months or even longer of conservative treatment, and they have already spent 50-60 thousand dollars on conservative treatment. In fact, looking back at the imaging was so severe that it was not suitable for conservative treatment at all. The end result is that you spend money and take time, and you end up needing minimally invasive or open surgical treatment. Another thing is not to believe the propaganda of individual treatments for lumbar protrusion, such as how severe someone is, and after a method of what is cured, this is not scientific. The scientific approach is, what kind of symptoms, signs, imaging changes, and what is the cure rate using that method. Finally, determine what its indications are, and then guide the promotion of the use of the method by a wide range of doctors. There is no natural authority, good doctors are practiced. Here is how to choose between conservative and non-conservative treatments People are not biological, people are social. Different people are very different and have very different levels of pain tolerance. The same imaging highlights that some people have very severe pain and others not so much. There are probably a few principles for choosing conservative treatment: 1. Most low back pain can be treated conservatively. Unless there are serious imaging changes, such as severe lumbar instability, slip, etc., simple low back pain can be treated conservatively. 2.If there are no cauda equina symptoms, most low back pain can be treated conservatively. 3.If pure pain most can be treated conservatively, if combined with numbness, weakness, need to be careful. 4.Imaging not serious low back pain, leg pain or lumbar leg pain Several principles for choosing non-conservative treatment: 1.With or without low back pain, intolerable radiating leg pain (sciatica) occurs. 2, the pain is not very serious, but very disturbing life and work, combined with serious imaging changes. 3.Low back pain, leg pain or lumbar and leg pain that is not treated by conservative treatment, plus serious imaging changes. 4.Sciatica that is clearly localized, but the imaging changes are not obvious. Closed treatment is needed to find the cause of pain. What is the time limit between conservative and non-conservative? Textbooks used to say that the duration of conservative treatment for lumbar disc herniation was 6 months. Times have changed and doctors nowadays do not follow this standard exactly. First of all the development of imaging has allowed doctors to gain insight into the changes within the lumbar spine. The efficacy of conservative treatment can have a roughly accurate judgment, do not have to lie 6 months later to tell the patient, you have this lumbar pain conservative treatment effect is not good, open surgery. For nothing, the patient suffers for a very long time. The significance is that it is not necessary to strictly follow the six-month period to advise patients to undergo conservative treatment. Disposition of the difference between imaging and clinical symptoms 1. severe symptoms + severe imaging = non-conservative treatment 2. not severe symptoms + severe imaging = conservative treatment or non-conservative treatment 3. not severe symptoms + not severe imaging = conservative treatment Choice of non-conservative treatments: including a variety of interventional treatments, a variety of minimally invasive surgery, and a variety of open surgeries Interventional treatments (ozone, condensate vaporization, PLDD, etc.): imaging not Severe cases Minimally invasive surgery (endoscopic surgery, various small incision surgeries) Severe disc herniation Various open surgeries (PLIF): cases with combined intervertebral space stenosis, lumbar spine instability, spinal stenosis, and degenerative scoliosis combined with low back and leg pain Selection of interventional treatments: For young patients, the use of ozone in large quantities is not recommended. The reason is that the use of ozone results in destruction of the intervertebral space and narrowing of the intervertebral space. Choice of minimally invasive methods: Endoscopic surgery is my favorite, and most (90%) of the time, excellent results can be achieved, no matter how severe the disc herniation is. The exceptions are combined lumbar instability, slip, degenerative scoliosis, spinal stenosis, and other pathologic changes.MED is a small incision procedure that we have abandoned. It has been replaced by endoscopy for its clinical efficacy with a much shorter hospitalization and recovery time than MED. Endoscopic surgery is not limited by bed space and can still be scheduled even if there is a shortage of beds on the ward. Because endoscopic surgery is a day surgery, come in the morning, operate in the afternoon, and bye-bye in the evening. The recent tight blood supply in hospitals has emphasized the advantages of minimally invasive surgery, as most minimally invasive surgeries do not require blood transfusions. The choice of open surgery: the two techniques mentioned above cover a relatively large number of indications, and the diseases that are amenable to open surgery are also serious problems such as spinal stenosis. The relationship between Western and Chinese medicine in the treatment of lumbar spondylolisthesis Chinese culture is profound and has accompanied the Chinese nation for thousands of years. We see its good side, but also to see the dregs of it, which requires the sudden friend to remove the false and keep the true. In the case of lumbago, most of the methods of Chinese medicine is to treat the symptoms but not the root cause. Most of them do not do any harm and most of them do not cost much. We can try, but if you meet spend tens of thousands of dollars does not relieve the method, we had better not choose. Western medicine treats the root cause by treating the symptoms, which is fast. However, the risk of Western medicine is greater than that of Chinese medicine. In addition to the problem of efficacy, some of them may easily lead to medical damage. The education of medical students in Western medicine is better than our ancestors did, and through the efforts of many people, the theories, methods, techniques and tools are getting better and better. This is one reason for the popularity of Western medicine. Whereas in our old ancestors, many good treatments were passed on to men but not to women. Passing them on can’t be done because there is only one daughter under family planning. The whole tools, techniques, methods, research methods, and theories need to be improved across the board. In the diagnosis and treatment of lumbar protrusion, Chinese and Western medicine can complement each other. For example, a nuclear magnet is done before massage to determine the risk of massage by the severity of the disease. Before and after the Western medicine treatment can be done before the Chinese medicine treatment, if there is a therapeutic effect, you can suspend the Western medicine surgery, if not effective and then Western medicine treatment so that the two are not delayed. It is recommended that when you ask questions, you should ask key important questions and be sure to upload imaging information at the same time, preferably a clear MRI. I suggest that you do not follow the “water posting”, do not ask questions about conservative methods, do not ask questions about rehabilitation. I have seen that many of my fellow mutants have already provided many good conservative and rehabilitation experiences from their own experiences, so we should just follow their experiences. Give more time to those who can’t decide whether they need non-conservative treatment or not.