Lumbar intervertebral disc herniation occurs between 20 and 50 years old, mainly due to degenerative disc lesions and repeated accumulation of injuries.
The lumbar disc has a herniated nucleus pulposus, which in turn compresses the nerve roots, resulting in low back pain or unilateral and bilateral sciatic nerve pain. Clinical symptoms are low back pain and sciatica. It directly affects the daily life and work of patients.
1. Clinical manifestations of lumbar disc herniation.
1. Low back pain. Most patients have low back pain immediately after or a few hours after a lumbar sprain, which can be tolerated and gradually reduced or disappeared after rest, while the severe ones are bedridden and have difficulty turning over, and the low back pain is reduced after long-term bed rest, leaving chronic low back pain, and the severe ones can develop into intractable low back pain.
2. Radiating pain in the lower limbs.
Low back pain usually develops days or weeks later and manifests as leg pain that radiates from the lower back to the thighs and back of the calves and calves, reaching the soles of the feet. First low back pain and then leg pain are more common, accounting for about 80% of patients, in most cases it is reversed, and the degree of pain gradually worsens.
Sciatica is initially unilateral, with pain that worsens when coughing or sneezing hard, symptoms recur, and pain in the contralateral leg or bilateral pain gradually appears.
3. Numbness and paresthesia.
After lumbar disc herniation, the nerves in the nerve root contact area will be subjected to local compression and traction compression, which will compress the fibers and blood vessels of the nerve root itself, resulting in ischemia and hypoxia, so abnormal sensations such as pain and numbness appear in the affected nerve root innervation area.
If the intervertebral disc herniation compresses or stimulates the paravertebral sympathetic nerve fibers, it can reflexively cause the blood vessel wall of the lower limbs to constrict and cause chills, coolness, and weakening of the dorsalis pedis artery in the lower limbs.
4. Restricted movement of the waist.
Most patients have varying degrees of lumbar mobility limitations, especially in the acute phase, with anterior flexion being the most pronounced, as anterior flexion can further promote posterior displacement of the nucleus pulposus and increase traction on the compressed nerve roots.
2. Clinical diagnosis of lumbar intervertebral disc herniation.
One of the important diagnostic bases for lumbar intervertebral disc herniation is physical examination, which is the diagnosis and localization of the disease through the special nerve manifestations produced by the affected nerve roots in different segments, and the use of anatomical signs, motor and sensory assessment tests, etc., so as to confirm or exclude the nerve damage site inferred from the history of pain, and make a preliminary clinical diagnosis.
It mainly includes straight leg elevation test (+), dorsal foot extension and strengthening test (+) bowstring test, dorsal foot extensor strength test, femoral nerve traction test (+) lower leg and dorsal foot ** sensory impairment, lumbar paravertebral radiating tenderness test (+), neck flexion test (+), lower limb paresthesia, tendon reflex attenuation, etc.
Another important diagnostic basis for lumbar disc herniation is ancillary tests, which mainly include x-rays: narrowing of the lumbar intervertebral space on lateral views. CT, MRI: location, size, shape, nerve root, dural compression and displacement of lumbar disc herniation
1) Dural compression deformation and displacement;
2) soft tissue shadows that protrude into the spinal canal;
3) swelling, compression and displacement of nerve roots;
4) Fragment formation and slippage;
5) Hymo's nodule formation;
6) Protruding partial calcification of the nucleus pulposus[3]. Electromyography: corresponding neurological findings.
3. Classification of lumbar disc herniation.
According to the clinical symptoms, it can be divided into:
1. Low back pain lumbar intervertebral disc herniation: the pain site is localized, occasionally reaching the buttocks, the disease is in the lumbar spinal canal, the disease site is deep, and there is no obvious radicular pain.
2. Nerve root compression type: low back and leg pain, lower limb radial swelling, numbness, stretching pain, motor weakness, reflexes, paresthesias, muscle atrophy, deep paravertebral tenderness in the lesion segment.
3. Spinal cord compression lumbar disc herniation: motor and sensory impairment, hyporeflexia, cauda equina nerve compression, urinary and urinary dysfunction.
Fourth, the herniation of lumbar intervertebral disc**.
1. Conservative**.
1) Acupuncture**: If the "dragon and tiger battle" acupuncture technique is adopted**, that is, take the acupoints Chengshan, Zhibian and Huatuo back, mounds and waist Yangguan, add blood sea and diaphragm acupoints for those with blood stasis, add Taixi and Kidney Yu acupoints for those with kidney deficiency, add moxibustion to the large vertebrae for those who are cold and sheng, and add Yangling Spring for those who are wet and heavy, so as to relieve the pain of patients and improve physical discomfort.
2) Massage techniques: For example, take the patient's Kidney Yu and Large Intestine Yu acupoints on the healthy side, Kidney Yu, Mingmen and Large Intestine Yu on the affected side, Jue Gu and Qi Hai Yu acupoints, first help the patient's low back pain position and sciatic nerve pathway to implement muscle relaxation solutions, such as kneading, rolling, etc., and then take corresponding conditioning methods;
Or the rolling method is used to operate on the back and outside of the patient's buttocks, waist and lower limbs, and then the lumbar intervertebral disc herniation position is continuously compressed, and the lumbar oblique plate method is implemented to guide the patient to passively straight-leg elevation, and with lumbar flexion and extension exercises, in order to effectively alleviate the symptoms of lumbar intervertebral disc herniation.
3) Comprehensive**: The factors that induce LDH, including not only mechanical pressure, but also aseptic inflammation, imbalance and ischemia are also the causes of its pathogenesis, so comprehensive ** is generally used in clinical non-surgical conservatism**.
For example, the use of "epidural cavity injection closure + manual massage + intravenous infusion B - escin sodium or mannitol + lumbar traction with lumbar back muscle function exercise" four-step ** has a good effect in **acute LDH, and it is also a relatively standardized and reliable non-surgical comprehensive ** currently recognized.
2. Surgery**.
1) Traditional surgery**. That is, the patient was given general anesthesia, guided to take the prone position, performed all the incisions in the middle of the posterior lumbar back, excised the hypertrophic ligamentum flavum in the intervertebral space to further expand the window to expose the dural sac and nerve root, and then completely excised the protruding osteophytes protruding from the nucleus pulposus and the posterior edge of the vertebral body, relieved the compressed nerve roots, routinely irrigated the wound, drained and placed catheters, and sutured the tissues sequentially, and routinely applied antibiotics after surgery [3].
However, this surgical method takes a long time to operate, and is more traumatic to the patient, and some even require internal fixation, and there are many complications, so it needs to be considered in combination with the patient's condition.
2) Percutaneous lumbar disc nucleus pulposus chemolysis (CN), which is one of the main methods of LDH in clinical practice, that is, with the help of collagenase hydrolysis of the patient's soft tissue, to dissolve the nucleus pulposus tissue, so that the water can be released, causing atrophy, and then reducing the pressure of the patient's intervertebral disc, so as to effectively relieve nerve root compression.
The allergic reaction of this method is relatively low in patients, but its long-term efficacy needs to be further studied.
3) Posterior lumbar discoscopy (MED), which is the most typical minimally invasive surgery for LDH diseases. The application of this surgical method can cause less damage to the surrounding tissues of the patient's body, can better alleviate the bleeding of the surrounding tissues, and will not cause great interference with the normal biomechanical structure of the patient's spine, and will not affect the stability of the patient's lower lumbar spine, greatly reducing the incidence of complications such as postoperative low back pain and spondylolisthesis, and the overall effect is remarkable.
In addition, the operation time will gradually decrease with the increase of the number of surgical cases, and the operation time and the surgeon's skill and experience will also have a certain impact on the surgical effect.
5. Prevention of lumbar intervertebral disc herniation.
Lumbar disc herniation is a frequent occurrence, so prevention is very important. When lifting and lifting heavy objects, try to avoid concentrating all the strength on the waist. Bending over for a long time can cause lumbar muscle strain, which can then develop into strain degeneration of the lumbar spine, so it should be avoided.
Once a lumbar sprain or strain occurs, it is necessary to carry out regular ** at an early stage to prevent the development of lumbar intervertebral disc herniation. The bed is too soft and too hard to fully relax the psoas muscles, and over time, psoas muscle strain will occur, which should be avoided.
After standing for a long time, we should pay attention to the movement of the waist, and should pay attention to the exercise of the strength of the lumbar muscles and abdominal muscles, which can play a role in protecting the lumbar spine and slowing down the process of spinal degeneration. Finally, once there is discomfort in the lower back and legs, early examination and early detection are simple and effective.
To sum up, with the gradual improvement of people's requirements and the gradual development of clinical medical level, the diagnosis and technology of LDH diseases have also made great progress.
Therefore, in the clinical diagnosis, it is necessary to give the patient the necessary imaging examination on the basis of the determination of clinical symptoms and signs, and then give the patient non-surgical ** or surgical ** according to the patient's condition, and guide the patient to carry out early functional exercises, so as to improve the overall effect of the disease and improve the quality of life.
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1] Li Feng. **Diagnosis of lumbar disc herniation and**[J].World Latest Medical Information Abstracts,2016,16(94):269
1] its Gema. Diagnosis of lumbar disc herniation**and **overview[J].Chinese Journal of Ethnic Medicine,2022,28(03):72-74doi:10.16041/j.cnki.cn15-1175.2022.03.031.