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Low back and leg pain is currently one of the most common medical factors in orthopedic clinic, causing many reasons for low back and leg pain, common causes are lumbar disc herniation, lumbar spinal stenosis, lumbar instability, slippage, degenerative scoliosis, spinal joint disorders, sacroiliac joint disorders, osteoporosis, lumbar muscle strain, spinal canal tumors, etc., among which lumbar disc herniation is the most common.
What is lumbar disc herniation?
Lumbar disc herniation is also known as lumbar disc fibrous ring rupture nucleus pulposus herniation. It is a lesion that after the degeneration of the intervertebral disc, under the action of external force, the fibrous ring rupture nucleus pulposus protrudes and stimulates or compresses adjacent nerve roots, spinal cord or blood vessels and other tissues, resulting in a series of clinical symptoms of low back and leg pain, such as lumbar pain, numbness, pain and weakness in one or both lower limbs. It belongs to the category of "low back pain" in Chinese medicine. Long-term repeated low back and leg pain often causes great pain to patients, affects the quality of life, and even loses the ability to work and live.
Do you have lumbar disc herniation?
See if the following symptoms are met
1. Low back pain: the most common, generally only low back pain in the early stage, can be acute severe pain or chronic dull pain, when the pressure of the intervertebral disc increases such as coughing, sneezing, defecation or bending over can cause pain or aggravation of pain.
2. Sciatica: mostly manifested as one side, pain radiates from the lower back to the buttocks, lower limbs, dorsum of the foot or the outside of the foot, which can be accompanied by numbness.
3. Cauda equina nerve compression: central lumbar intervertebral disc herniation, due to the direct action of the protruding tissue, the cauda equina nerve is compressed, manifested as bilateral thighs, calves, posterior heels and perineal dullness, large and urine dysfunction.
4. Others: Some patients' affected limbs may appear cold, coccygeal pain, calf edema, etc.
Which people are easy to get
What about lumbar disc herniation?
1. Manual workers: engaged in physical labor, especially men who are about 30~45 years old and have been in a state of high-intensity labor for a long time, the probability of suffering from lumbar disc herniation is significantly higher than that of others.
2. Special occupations: drivers, athletes and other special occupations often sit or stand for a long time during long-term work or training, and the waist bearing weight is too heavy, which may compress local nerve root tissue and induce lumbar disc herniation.
3. Abnormal lumbar development: congenital lumbar disc dysplasia or deformity, lumbar sacralization, vertebral arch disintegration and other people, will also affect the normal function of the lumbar spine, increase the extra burden on the waist and induce the occurrence of lumbar disc herniation such as low back pain.
What should I do if I have a herniated lumbar disc?
Do I have to have surgery? Can it be treated conservatively?
On the one hand, due to the repeated attacks of lumbar process, many patients think that simple conservative treatment is ineffective, but delays the condition; On the other hand, because the lumbar spine is the backbone of life, many patients think that lumbar spine surgery is too risky and will be paralyzed if it is not done well, so they are very afraid of surgery and hesitate. In fact, for the lumbar process, conservative treatment or surgical treatment, clinical needs to be judged according to the different degrees of lumbar spine lesions and the different symptoms of patients.
1. Conservative treatment
Most patients with lumbar disc herniation can be relieved or cured with non-surgical treatment.
Suitable for:
(1) Those who are young, have a first onset or have a short course of disease;
(2) Those with mild symptoms and self-relief after rest;
(3) Imaging examination did not show obvious spinal stenosis.
Specific treatment modalities:
(1) Absolute bed rest
It varies according to the severity of low back and leg pain and the length of the disease. Generally, if the initial attack and severe pain are severe, a wooden bed can be used, with a thick cushion, and lie on the back to rest; Patients with mild pain and long course of disease do not need to stay in bed all day, and can get out of bed for a short time 2~3 times a day, and protect with waist circumference during activity. If the symptoms of bed rest are not relieved for 3~4 weeks, minimally invasive interventional treatment or surgery can be considered.
(2) Wear a waistline
First of all, the size of the waist should be adapted to itself, with its upper edge reaching the lower edge of the costal arch and the lower edge reaching the upper edge of the hip. The posterior side of the waist should be flat or slightly convex forward. Secondly, the wearing of waist circumference should be mainly short-term, usually about 1 week, and can be lifted after the symptoms are relieved to prevent muscle atrophy and weakness, and the longest time is not more than 1-3 months. Finally, waist circumference should be worn under the guidance of a doctor, and lumbar back muscle rehabilitation training should be gradually increased to prevent and reduce muscle atrophy and lumbar instability.
(3) Symptomatic treatment of traditional Chinese and Western medicine drugs
According to the priority of the patient's condition and response to treatment, oral non-steroidal anti-inflammatory drugs and muscle relaxants can be selected as appropriate; Intravenous medication (comprehensive symptomatic treatment of analgesia, dehydration, hormones, nutritional nerve drugs, continuous use for 3~5 days); At the same time, according to the differentiation of low back pain, traditional Chinese medicine differentiation can be used oral low back pain fixative, solitary parasitic soup, etc.
(4) Traditional Chinese medicine characteristic external treatment and acupuncture and tuina treatment
Traditional Chinese medicine features ironing, rubbing and other treatments to relieve pain with warm meridians, and acupuncture and tuina treatment to activate blood circulation and remove stasis and relieve pain.
(5) Rehabilitation
Physical factor therapy and manual therapy can relieve muscle spasms and reduce pressure in the intervertebral disc, but it should be noted that violent massage can lead to aggravation of the disease, and caution should be taken. Traction therapy can also be used to increase the width of the intervertebral space, reduce the pressure in the intervertebral disc, retract the herniated part of the intervertebral disc, and reduce the stimulation and compression of the nerve root, which needs to be carried out under the guidance of a professional doctor.
(6) Functional exercise
During the remission period, the lumbar back muscle function exercise is started to strengthen the protective function of the back muscles. Functional exercises mainly include core muscle strength training such as "five-point", "three-point" and "Xiaoyanfei".
The "five-point" method is to use the head, elbows and heels as support points, and vigorously raise the waist and hips. After the function of the lumbar back muscles is strengthened, you can switch to the "three-point" exercise method of using the three points of the head and heel as support. Exercise should be gradual, gradually increased, to avoid fatigue.
(7) Injection treatment
Local injection of hormones and local anesthetic drugs has anti-inflammatory and analgesic, reduces the chemical inflammatory stimulation of nerve roots by protruding nucleus pulposus, and reduces radicular edema, thereby improving the symptoms of low back and leg pain. Such as: intervertebral disc block, nerve root block, epidural steroid injections (ESIs) and other treatments.
If the symptoms do not improve significantly after 6~12 weeks of conservative treatment, and the symptoms are acute or progressively aggravated, surgical treatment should be considered to prevent delaying the timing of surgery.
2. Surgical treatment
Suitable for:
(1) The diagnosis is clear, although it is the first time, the pain is unbearable, which seriously affects the patient's life and work.
(2) After 6~12 weeks of strict conservatism, if the symptoms do not decrease, or even worsen, surgery and treatment should be performed as soon as possible.
(3) Although it is effective after conservative treatment, it has repeated attacks after exertion, affecting life and work.
(4) Cauda equina nerve injury syndrome or single nerve.
(5) This disease is accompanied by severe neurogenic intermittent claudication, and imaging confirms that it is spinal stenosis.
Surgical method:
(1) Minimally invasive surgery: minimally invasive treatment of lumbar disc herniation includes two categories: one is percutaneous puncture interventional techniques, including radiofrequency nucleoplasty, nucleus pulposus chemolysis, percutaneous discotomy, etc.; The other category is endoscopic assisted techniques developed on the basis of percutaneous puncture lumbar discectomy technique, including percutaneous intervertebral foramen nucleus pulposus extraction (PELD) and translaminar intersectional endoscopic nucleus pulposus extraction (MED) for lumbar disc herniation.
(2) Traditional open surgery: Open surgery is currently the most widely used surgical method for the treatment of lumbar disc herniation at home and abroad. Including: total laminectomy, discectomy, hemilamectomy, laminectomy, discectomy, etc. This type of surgery is characterized by a large field of view, easy to operate, surgery can directly remove the nucleus pulposus, and the decompression of the nerve root is also relatively sufficient. However, the disadvantage is that the decompression range during surgery is too large, which often destroys the structure of the posterior column of the spine and affects the stability of the spine.
Lumbar disc herniation
How can it be prevented in daily life?
1. Maintain the correct posture of the lumbar spine (lumbar lordosis), choose a chair with a high and backrest when sitting, and choose a hard bed for the lying position.
2. Learn labor-saving posture movements, such as knee bending and hip squatting when lifting heavy objects, avoiding straight legs bending over to lift objects, and at the same time, heavy objects should be as close to the body as possible.
3. In a certain period of time, the position should be adjusted at any time, do not be in a posture for a long time, such as sitting for a long time, especially for a long time bending is most likely to cause posterior disc protrusion.
4. Avoid sudden force during lumbar scoliosis and torsion, and when it cannot be avoided, you should also do warm-up exercises first to enhance the load resistance of the spine.
5. When driving, the driver's seat should be adjusted to sit upright, the neck should move freely, and the back and waist should have sufficient and balanced support.
6. Excessive collision, twisting, jumping and other actions should be avoided when exercising, and in principle, all sports that will produce foot vacancy or excessive twisting of the waist should be avoided during exercise.
7. When sneezing and coughing, it is easy to strain the back muscles and increase the pressure of the lumbar intervertebral disc, and the knees and hips are slightly flexed at this time.
8. Functional exercise can improve local blood circulation, reduce and eliminate edema of soft tissues around the lumbar intervertebral disc, delay and prevent intervertebral disc herniation. However, do not exercise with excessive strenuous intensity. The following lumbar exercises can be done: (1) waist stretching; (2) Fish jumping lumbar back muscle exercise.
9. Pay attention to the warmth of the waist to avoid cold.