Lumbar disc herniation is only one type of disc lesion, and the most common one. It is true that many other causes of low back pain are also related to disc lesions, but they are different from “herniated disc” in terms of pain mechanism, location, and performance. Today we want to clarify the most common clinical disc lesion DD lumbar disc herniation, how it is related to low back pain, and what harm it can cause besides low back pain. How to prevent and treat it. There are many medical terms to describe herniated disc, such as “herniated disc”, “bulging disc”, “prolapsed disc”, “disc disease”, “sciatica”, “black disc” and so on. In fact, these are all terms used by physicians to describe the different stages of herniated disc pathology. It is important for the patient to know the source of your pain and how to deal with it. Therefore, when you see your doctor, do not start with a diagnosis of a herniated disc, but describe your pain in detail and leave it up to the doctor to determine what is going on. How does the doctor diagnose a herniated disc? In a patient who visits a doctor for low back pain, the doctor’s clinical thinking is focused first on identifying the source of the pain. Therefore, it is clearly not right to rely on magnetic resonance imaging (MRI) and CT right off the bat. A proper spine specialist will ask you in detail about the history of your back pain, how it started, and whether it is accompanied by leg pain. Whether the pain feels like soreness, tingling or numbness, whether the pain is related to the position, and what can trigger the pain ……. Then do a thorough physical examination (usually done by the doctor with his bare hands, with the use of some small tools, such as a snapping hammer, cotton swabs, etc.), mainly to test the strength of the patient’s muscles and the function of the nerves. For example, the knee reflex is normal, and the straight leg raise test, which can induce leg pain, is performed. On the basis of these tests, the doctor already has a basic understanding of your pain. At this point, depending on the condition, your doctor will recommend further tests. Commonly used are x-rays, CT and MRI, which we call imaging tests. These tests can tell the doctor exactly where the herniated disc is located and how much pressure is being put on the nerve. Sometimes even invasive tests, such as discocentesis, are required. The cost of these tests is not low relative to the Chinese population, and doctors will consider them carefully. But the significance of these tests is important, especially for further treatment, whether conservative, or surgical, and how to be conservative and how to be surgical, all have clear guidelines. The next consideration for your doctor is to distinguish the type of pain you have. There are two main types of pain caused by disc lesions. One is the pain caused by the herniated disc compressing or stimulating the nerves that innervate the lower extremities, commonly known as sciatica. This pain is clinically known as “radiating pain”. These patients mainly have pain in the lower limbs, and the pain is mainly concentrated below the knee joint. This is a typical case of “lumbar disc herniation”. The patient often feels that the leg pain is more severe than the lumbar pain, or has had significant lumbar pain for some time, but once the leg pain becomes significant, the lumbar pain is reduced. So remember, the main danger of a herniated disc is that the herniated disc presses on the nerves that innervate the lower extremities, causing impairment of the function of those nerves. The other type of pain is primarily in the lower back, with only some mild, intermittent pain and discomfort in the lower extremities, if any at all. This is because the degenerated disc itself becomes the source of the pain, since the disc is also innervated. This type of pain, which we call “axial pain,” is a pain that manifests mainly in the mid-axis of the trunk (on both sides of the back) to distinguish it from the radiating pain caused by compression of the peripheral nerves. This pain is no longer attributed by spine specialists to “paravertebral herniation,” but rather to another diagnosis: degenerative disc disease, or DDD, which is more complicated to treat than herniated discs in some ways, as I will explain later. It is important to emphasize that a doctor who does CT or MRI right away is definitely not a good doctor. The so-called herniated disc, nerve root compression, bulging or prolapsed disc, these are all imaging concepts that we see on CT or MRI. Imaging evidence, although important, does not mean that they are the source of pain. middle-aged and elderly people in their 60s, almost everyone with a mild or even severe herniated disc on CT or MRI, can have no back or leg pain whatsoever. Therefore, imaging evidence is only meaningful when it is consistent with the clinical history, signs (physical examination findings). I always emphasize to residents and trainees that we are seeing patients for treatment and must not look at films for treatment. We must first find the problem through detailed history and examination, and then confirm it through imaging, and only when the three are in complete agreement can we draw a conclusion. The first two are the essence, the latter is the end, do not put the cart before the horse. How is the pain of a herniated disc caused? So, how is the pain of a herniated disc caused? When the disc degenerates (a process that begins after the second decade of our lives), the nucleus pulposus in the center of the disc can protrude posteriorly into the spinal canal. The weakest point at the back of the disc is exactly where the nerve roots (where the nerves emanate) are located, and once the herniated disc presses here, it can cause pain throughout the innervated area (from thigh to foot). With prolonged compression, the nerve can become degenerated or even necrotic, and clinical symptoms of numbness can occur. About 90% of lumbar disc herniations occur between lumbar 4/5 and lumbar 5/sacral 1 (L4/5, L5/S1 ), causing pain in the fifth lumbar nerve and the first sacral nerve. These two nerves are the main component nerves of our sciatic nerve, which is the origin of “sciatica”. The compression of the fifth lumbar nerve is mainly manifested by the inability of the big toe to crane upward (dorsiflexion) or difficulty in dorsiflexion of the ankle joint (foot drop), and numbness and pain at the tip of the foot. Compression of the sacral 1 nerve is manifested by the inability to straighten the ankle joint, which is fatal for ballerinas. There is also pain and numbness radiating to the lateral aspect of the foot. What is the conventional treatment? Once the cause of the low back pain is identified, the treatment options are quite different. For low back pain caused by a herniated disc, most patients first choose conservative treatment. The human body has the ability to heal itself for many of its own diseases. If the herniation is not very severe and can heal itself, this process can often be completed within 6 weeks. For patients who are experiencing a herniated disc for the first time, cherish the opportunity God has given you. See a spine specialist who will give you a good recommendation. The purpose of these treatments is to help you overcome the pain caused by the herniated disc. More importantly, it is important to rest during these six weeks, with strict bed rest for about one week during acute painful episodes. After that, perform some light activities. Wait for 6 weeks and then gradually return to normal work and life. If the pain is still not relieved, minimally invasive discectomy surgery can be considered. There are many ways to perform these surgeries, and I will talk about each of them later. For most patients, at this point, a herniated lumbar disc is basically curable. In fact, 80% of patients diagnosed with discs in the outpatient setting can be treated conservatively, with another portion resolving the problem with minimally invasive treatment. Less than 10 percent actually require surgery. With the development of spine surgery technology, disc surgery has become as simple as appendicitis surgery in large hospitals or large spine specialties. The use of advanced tools such as discoscopes or microscopes allows for minimal surgical trauma to the patient. In cases of simple disc herniation, if conservative treatment fails, surgery is the only effective way to relieve pain and prevent further nerve compression and degeneration in the short term. Successful surgery allows the patient to be out of bed within a day or two and back to work within 3 weeks. Of course, this time cannot be absolute and must be judged based on the patient’s preoperative severity. For an experienced spine specialist, the success rate of surgery is over 95%. Usually, the surgery requires the removal of only a very small portion (5 to 8 percent) of the disc, with the majority of the disc tissue remaining intact.