In the outpatient clinic, many patients with low back pain will ask: "My low back pain, is the lumbar disc herniation", patients diagnosed with lumbar disc herniation often have a lot of questions, such as: what is the disease of lumbar disc herniation, what are the symptoms, whether it needs to be treated, what examination, how to treat, whether surgery is needed, how to improve symptoms, how to prevent, and so on.
Let's talk about the related issues that many of you are concerned about.
1. What is lumbar disc herniation?
Lumbar disc herniation is a lumbar disorder that can cause low back pain and pain, numbness, or tingling down to the legs. The lumbar disc has a tough shell (fibrous ring) and a central colloid (nucleus pulposus). The shell of the lumbar disc sometimes ruptures, leaking out the gelatinous substance inside, which is the lumbar disc herniation. Leaking gelatinous substances can stimulate nearby nerves, so herniated discs can cause symptoms such as pain and numbness in the lower back and legs.
Schematic diagram of lumbar disc herniation
2. What are the symptoms of lumbar disc herniation?
The most common symptom of lumbar disc herniation is low back pain and tingling, pain, or numbness that extends down to one side of the leg. These symptoms affect different parts of the leg, depending on the lumbar disc segment that is prominent. Leg pain in lumbar disc herniation can be suddenly aggravated by bending over, lumbar spine weight bearing, trauma, more severe than low back pain, and is caused by compression of nerves by herniated nucleus pulposus tissue.
3. Do I need to see a doctor?
If the above symptoms occur, it is recommended to go to the spine surgery department of a regular hospital. If there is new pain that extends into the groin or legs, accompanied by symptoms such as leg weakness or loss of control of bowel movements, and sagging feet (inability to hook the feet while walking), you should see a doctor immediately.
4. Do I need to do an examination?
Although lumbar disc herniation can be diagnosed by history and physical examination, imaging tests are still needed to rule out other conditions, such as tumors or infections.
Because ordinary X-rays cannot show the discs, only the intervertebral space, indirectly infering whether there is disc lesions, the diagnostic role is limited, but x-rays can show infections, tumors, or other abnormalities, so this test is necessary.
Imaging tests such as CT (tomography) or MRI (magnetic resonance imaging) can show images of internal lumbar tissue, especially MRI can clearly show the compression of the diseased discs and nerves, so the most effective test for lumbar disc herniation is MRI.
MRI of the lumbar spine shows: lumbar 4/5 disc herniation
5. How to treat it?
Only a small number of patients with severe disease eventually need surgery, conservative treatment is enough to treat most patients, such as: anti-inflammatory analgesics, muscle relaxants, nutritional nerves, anti-edema drugs, physiotherapy, tuina (implemented by regular medical professionals), acupuncture, massage (regular medical professionals), etc.; under the premise of the above treatment, for acute low back pain, the simplest treatment option is bed rest for 2 days, semi-Fowler recumbent position (hip bending side lying position) and a pillow between the legs (as shown in Figure 3), On the premise of feeling comfortable, the patient is allowed to walk, but does not advocate sitting, especially driving. Continuing general activities to the extent that the pain allows for faster recovery from the condition.
Semi-Fowler recumbent position
6. How can I improve my symptoms?
More and more evidence-based medical evidence shows that bed rest does not reduce the patient's pain level and promote the patient's functional recovery compared with daily activities, so patients with lumbar disc herniation can maintain daily activities, even if there is some pain, they should not stay in bed for a long time. However, it is necessary to pay attention to the posture of daily activities and try to avoid lumbar twisting, flexion and excessive weight bearing.
7. Can lumbar disc herniation be prevented?
It is sometimes assumed that herniated discs are caused by lifting objects in the wrong way or somehow straining the waist, but there is not much evidence that moving or lifting in the wrong way can cause a herniated disc.
According to experience, correct posture, reduce sedentary, avoid lumbar trauma, reduce stooping weight-bearing activities, and regular low back muscle function exercises may be able to prevent lumbar disc herniation to a certain extent.
8. Can conservative treatment be good and easy to recur?
Lumbar disc herniation generally has a benign natural course, and most of the symptoms of lumbar disc herniation can be improved by conservative treatment. Therefore, conservative treatment should be the preferred treatment for lumbar disc herniation without significant neurological impairment. Herniated lumbar discs usually atrophy to varying degrees over time, and clinical function can also be improved. The literature reports that most patients with lumbar disc herniation can improve their symptoms after 6 to 12 weeks of conservative treatment, so for cases without significant neurological damage, the recommended time for conservative treatment is generally 6 to 12 weeks. The success rate of conservative treatment is about 80-90%, but the recurrence rate of clinical symptoms can reach 25%.
9. Under what circumstances do surgery need?
Surgical treatment usually improves symptoms faster and to a greater extent than non-surgical treatment, is done in a safe manner, has a lower incidence of complications, and requires surgery in the following situations:
1. The history of lumbar disc herniation is more than 6-12 weeks, and the systemic conservative treatment is ineffective, or the symptoms are aggravated or recurrent during conservative treatment;
2. Lumbar disc herniation pain is severe, or the patient is in a compulsive position, affecting work and / or life;
3. Lumbar disc herniation has single nerve palsy or cauda equina nerve palsy, which is manifested as muscle paralysis or rectal and bladder symptoms.
Schematic of foraminoscopic surgery
The Second People's Hospital of Hunan Province (Hunan Provincial Brain Hospital) Spine Surgery (Intervertebral Disc Disease Diagnosis and Treatment Center) has formed a complete treatment system for intervertebral disc diseases, from conservative treatment to minimally invasive surgical treatment to open surgical treatment, and the treatment effect of intervertebral disc diseases is accurate, and it has been unanimously praised by the majority of patients and peers.
Contributed by: Gai Jingying, Department of Spine Surgery, Second People's Hospital of Hunan Province (Hunan Brain Hospital).
Editor: Liu Yuchen
Image: From the Internet, intrusion and deletion