I. Overview Lumbar disc herniation refers to a series of symptoms caused by the herniated nucleus pulposus of lumbar intervertebral discs compressing the surrounding nerve tissues. It is a kind of lumbar and leg pain which is more common in the clinic, and it is mainly due to the different degrees of degenerative changes of various parts of the lumbar intervertebral discs (nucleus pulposus, annulus fibrosus, and cartilages), especially the nucleus pulposus, and then the fibrous annulus rupture of the intervertebral discs under the action of external factors. The nucleus pulposus protrudes from the ruptured area (or comes out) in the back or the spinal canal, which leads to irritation or compression of adjacent tissues, such as the spinal nerve roots and spinal cord, resulting in lumbar pain, numbness and pain in the lower limbs or both lower limbs in general, and perineal numbness and tingling in the perineal area due to the compression of cauda equina, dysfunction of bowel and urination, urinary incontinence in females and impotence in males, and loss of control of bowel and urinary control in the severe cases and incomplete paralysis of both lower limbs, and a series of clinical symptoms. In severe cases, there is loss of bowel control and total paralysis of both lower limbs. Second, lumbar disc herniation classification: lumbar disc herniation according to the direction of the nucleus pulposus protrusion can be divided into: (1) unilateral type lumbar disc herniation, generally only produce one side of the lower limb symptoms. (2) Bilateral lumbar disc herniation, which produces bilateral lower extremity symptoms. (3) Central type lumbar disc herniation, can compress the cauda equina, manifested as perineal paralysis and urinary and fecal symptoms. Third, lumbar intervertebral disc herniation etiology and pathology after puberty, various human tissues will appear degenerative changes, including intervertebral disc changes occur earlier, the main change is the nucleus pulposus is dehydrated, dehydration of the intervertebral disc to lose its normal elasticity and tension, on this basis due to the heavy trauma or repeated repeated inconspicuous injuries, resulting in fibrous annulus weakness or rupture, the nucleus pulposus is protruding from the site, the compression of the nerve root to produce nerve root injury. The nucleus pulposus may protrude from the center to the back, compressing the cauda equina and causing urinary and defecation disorders. If the fibrous ring is completely ruptured, the broken nucleus pulposus tissue enters the spinal canal, which can cause extensive damage to the cauda equina. Due to the heavy burden on the lower lumbar region and the many activities, herniation occurs mostly in the lumbar 4-5 and lumbar 5-sacral 1 space. Fourth, lumbar intervertebral disc herniation symptoms 1, lumbar pain and one side of the lower extremity radiating pain is the main symptom of lumbar intervertebral disc herniation. Lumbar pain often occurs before leg pain, or both at the same time; most of them have a history of trauma, or no clear cause. The pain has the following characteristics: A radiating pain along the sciatic nerve conduction, directly to the lateral calf, the dorsum of the foot or toes. In the case of lumbar 3-4 interspace herniation, radiating pain toward the anterior thigh is produced by compression of the lumbar 4 nerve root. B All actions that increase cerebrospinal fluid pressure, such as coughing, sneezing, and defecation, can exacerbate low back pain and radiating pain. C Pain increases with activity and decreases with rest. Bed position: most patients adopt the lateral position, and flexion of the affected limbs; individual severe cases in various positions are painful, can only flexion of the hip and knee kneeling on the bed to relieve the symptoms. Combined with lumbar spinal stenosis, there is often intermittent claudication. 2.Scoliosis deformity: the main curvature in the lower lumbar region, more obvious when forward bending. The direction of lateral curvature depends on the relationship between the protruding nucleus pulposus and the nerve root: if the protrusion is located in front of the nerve root, the trunk is generally bent to the affected side. 3. Restricted spinal activity: the protruding nucleus pulposus compresses the nerve root, making the lumbar muscles tense in a protective manner, which may occur unilaterally or bilaterally. Due to the tension of lumbar muscles, the physiologic convexity of lumbar spine disappears. The spine is limited in forward flexion and backward extension, and radiating pain to one side of the lower limb may occur when forward flexion or backward extension is performed. 4, lumbar pressure pain with radiating pain: there are limited pressure points next to the affected spinous process of the herniated disc, accompanied by radiating pain to the calf or foot. V. Diagnosis and examination of lumbar disc herniation Most patients with lumbar disc herniation can be correctly diagnosed according to clinical symptoms or signs. X-ray film should be taken lumbosacral spine of the positive, lateral film, if necessary, plus the photo of the left and right oblique film. x-ray signs can not be used as a basis for the diagnosis of lumbar disc herniation, but it can be used to exclude some of the disease. In case of diagnostic difficulties, special examinations such as spinal cord iodine oil imaging, CT scan and magnetic resonance may be considered to clarify the diagnosis and the location of the herniation. Patients with no obvious abnormality in the above examinations cannot completely exclude lumbar disc herniation. Treatment of lumbar intervertebral disc herniation (a) Non-surgical treatment of lumbar intervertebral disc herniation. Resting in a hard bed, supplemented by physical therapy and massage, can often relieve or cure. Prone traction by shaking reset simple, high cure rate, easy for patients to accept, for the commonly used non-surgical treatment. (ii) Surgical treatment. Lumbar disc herniation surgery indications are: ① non-surgical treatment of lumbar disc herniation is ineffective or recurrence, the symptoms of heavy impact on work and life. ② nerve damage symptoms are obvious, extensive, and even continue to deteriorate, suspected of complete rupture of the intervertebral disc annulus fibrosus nucleus pulposus fragments protruding into the spinal canal. (iii) Centralized lumbar disc herniation with urinary and fecal dysfunction. (4) Lumbar intervertebral disc herniation combined with obvious lumbar spinal stenosis. Heavy labor should be avoided within six months after surgery.