Must lumbar keyboard protrusion be treated surgically?

The choice of treatment for lumbar disc herniation depends mainly on the different pathological stages and clinical manifestations of the disease. Surgical and non-surgical treatments have their own indications, and most lumbar disc herniations can be cured by non-surgical treatments. The appropriate treatment method can be adopted only after understanding the medical history, carefully examining the body and comparing the relevant special examination items. In recent years, the imaging technology used for the diagnosis of lumbar disc disorders has advanced greatly, including X-ray plain film, discography, CT, ultrasound, magnetic resonance and myelography. In general, plain radiographs can be used for diagnostic purposes, while MRI is used for difficult cases (or refer to ultrasound and CT, but its confirmation rate is low). Myelography is not easily used unless it is a last resort. 1, lumbar spine X-ray plain film (1) posterior-anterior film (ortho): mostly shows lumbar scoliosis sign, the width of the vertebral space is mostly unchanged in the early stage of the lesion; if the disease is longer, it shows the narrowing of the vertebral space and the appearance of various forms of bone spurs at the edge of the vertebral body. The deviation of the spinous process is more common but not necessarily significant. (2) Lateral radiographs: their diagnostic value is more important than the former. (3) Oblique films: mainly used to exclude lower lumbar arch rupture and lumbosacral (or sacroiliac) joint lesions. In patients with simple disc prolapse, there are no special findings; therefore, this film is not necessary for those with a clear diagnosis. 2. CT examination The application of CT examination of the spine and spinal canal lesions has been widely carried out in clinical practice. CT images with relatively high resolution can show the site, size, shape and image of nerve roots and dural sac displacement of disc protrusion more clearly, and can also show the hypertrophy of the vertebral plate and ligamentum flavum, hyperplasia of small joints, narrowing of the spinal canal and lateral saphenous fossa, etc., and can reconstruct the three-dimensional technology of the spinal canal and root canal. The emergence of magnetic resonance imaging (MRI) can be said to be a major advance in imaging, non-invasive and non-radioactive damage in any previous means of examination can not be compared, its image of human tissue structure display, compared with CT examination more accurate and real. MRI examination is of great importance in the diagnosis of disc herniation. Through sagittal images at different levels and cross-sectional images of the involved disc, the morphology of the herniated disc and its relationship with the dural sac, nerve roots and other surrounding tissues can be observed. In addition to obtaining three-dimensional images for diagnosis (with a positive rate of more than 99%), MRI can also be used to locate and distinguish between “bulge”, “herniation” and “prolapse “This can facilitate the choice of treatment and surgical approach.