Many patients are only in their teens......

Many patients are only in their teens, and they are wary of the young age of lumbar disc herniation

Lumbar disc herniation is a relatively common degenerative disease of the spine, which is more common in middle-aged and elderly people. However, the reporter's investigation found that in recent years, the number of adolescent lumbar protrusion patients has increased, and some children are only teenagers who suffer from lumbar protrusion, which affects normal life and learning.

A teenager has lumbar protrusion

Since last fall, Xiaole (pseudonym), a 16-year-old boy from Taiyuan, Shanxi Province, has often complained of back pain. At first, the parents didn't care, but later "it hurt from the waist, buttocks, and legs", and even couldn't sleep well in severe cases. The parents were in a hurry and took their child to the hospital for treatment, and the examination found that he had a lumbar intervertebral disc herniation.

"I only knew that older people had this disease, how could I have thought that children would also get it?" Xiaole's mother, Ms. Wang, was both remorseful and surprised. After consulting a doctor, she learned that Xiaole suffered from lumbar protrusion, which was likely related to his frequent sedentary and too little exercise. "He usually doesn't like to move, and he doesn't get up much during recess, so he sits in his seat, plus he has a heavy workload of schoolwork, and he writes his homework late when he goes home, and the pressure on his lumbar spine is too great. ”

Interviews with reporters found that similar cases are not uncommon.

"During the winter and summer vacations, there are many children who come to the clinic because of back pain. Sometimes there are 30 numbers in an outpatient clinic, and nearly one-third are students. Wang Rui, deputy chief physician of the Department of Orthopedics of Shanxi Bethune Hospital, said that in the past, his minimally invasive surgery for the lumbar process was mainly focused on people aged 50 to 75, but in recent years, the number of patients under the age of 20 has increased, and the youngest patient is only 14 years old.

"Five or six years ago, it was rare to see adolescent patients with lumbar protrusion, but in the past two years, it can be said that it is not uncommon. Wang Pingzhi, chief physician of the Department of Rehabilitation Medicine of Shanxi Bethune Hospital, said that as a degenerative disease, lumbar protrusion should not occur in adolescents, but from a clinical point of view, there is a trend of increasing number of adolescent lumbar protrusion patients.

According to the clinical data provided by the Spine Surgery Center of Zhongda Hospital Affiliated to Southeast University, the number of patients under the age of 21 who have undergone minimally invasive surgery for lumbar protrusion in the hospital has increased significantly in the past 10 years, with about 100 cases in the six years from 2014 to 2019, and more than 120 cases in the four years from 2020 to 2023, with the highest incidence of patients between the ages of 16 and 19.

"The number of surgeries for adolescent patients is really increasing. Zhu Bin, deputy chief physician of the Department of Orthopedics of Beijing Friendship Hospital affiliated to Capital Medical University, and his team have carried out minimally invasive surgical treatment for juvenile lumbar protrusion for a long time, and more than 270 cases of adolescent lumbar protrusion have been treated by him in the past 10 years, and the number is increasing year by year. "The incidence of lumbar protrusion in adolescents is between 0.1% and 0.2%, which is lower than that of adults, but it tends to place a greater burden on patients and families. Zhu Bin said.

The picture shows Zhu Bin (second from right), deputy chief physician of the Department of Orthopedics of Beijing Friendship Hospital affiliated to Capital Medical University, operating on a patient with lumbar protrusion. Photo courtesy of the interviewee

Why is lumbar protrusion at a young age?

According to reports, lumbar protrusion is based on the degenerative changes of the lumbar intervertebral disc, due to external forces and other factors that lead to the rupture of the annulus fibrosus, and the nucleus pulposus protrudes from the breach and compresses the adjacent nerves, causing pain, numbness, soreness and other symptoms in the waist and legs.

The reporter learned from the interview that congenital developmental abnormalities are an important factor leading to adolescent lumbar protrusion. However, at the same time, the phenomenon of acquired pathogenesis is intensifying, which needs urgent attention.

A number of interviewed experts said that at present, many teenagers often sit for a long time, some children take a lunch break on their stomachs, and some children carry too heavy schoolbags every day, which will bring about an increase in the pressure load of the lumbar intervertebral disc and "age" the lumbar spine.

Several experts mentioned that some children use desks and chairs that do not match their height. Wang Pingzhi pointed out that today's children generally grow taller and faster, and the big man sits at a small table, which can easily increase the pressure on the lumbar intervertebral disc.

The reporter learned that according to the national standard GB/T 3976-2014 "Functional Dimensions and Technical Requirements for School Desks and Chairs" implemented in 2015, there are 11 models of desks and chairs in primary and secondary schools from No. 0 to No. 10, which correspond to different student heights. However, in reality, the height of desks and chairs in many schools does not meet the height requirements of students.

The reporter randomly measured some desks and chairs in the first grade of a middle school in Taiyuan, and found that the situation of inconsistent with the national standard was more common. The height of some desks is about 735mm, which is close to the No. 2 desk (730mm high), and the corresponding height range is 165 to 179cm. However, some students who use this type of desk are more than 180cm tall, and some of the seats equipped with these desks are 460mm high, much higher than the standard of 420mm in the national standard No. 2.

Inadequate physical activity is another important cause.

Wang Rui pointed out that insufficient physical exercise, low back muscles, paravertebral muscles and ligaments can not be effectively exercised, and the support for lumbar intervertebral discs is insufficient, which increases the risk of lumbar protrusion.

It is worth noting that many experts mentioned that the surprise response to the physical examination of the high school entrance examination will also increase the risk of lumbar protrusion. Wang Pingzhi told reporters that every month or two before the physical examination of the high school entrance examination, the number of students who come to the clinic will increase significantly, and many of them have back pain. In particular, in some areas, sit-ups and seated forward bends are listed as physical test items in the high school entrance examination, and if there is no good training foundation in peacetime, the risk of injury is greater in assault reinforcement.

Qiao Fucun, a physical education teacher at Ding Hui Experimental Primary School affiliated to Zhejiang Normal University, said that some physical education teachers and parents suggested that the high school entrance examination should cancel the sit-ups and sitting forward bending items.

Experts also point out that there is a significant correlation between juvenile lumbar protrusion and obesity. Zhu Bin said that nearly half of the children with lumbar protrusion are obese. Some children are tall and big, and some weigh more than 200 pounds, "obesity will lead to weakness of lumbar muscles, reduced stability of the lumbar spine, and increased pressure on the lumbar intervertebral disc."

Take care of the lumbar spine health of adolescents together

The interviewed experts pointed out that once the lumbar intervertebral disc degenerates irreversibly, adolescents suffer from lumbar protrusion prematurely, which will have a lifelong impact on life, study and work, and most people have to "deal with doctors for a lifetime", among which women will also face additional risks during pregnancy and childbirth.

Mao Lu, deputy chief physician of the Spine Surgery Center of Zhongda Hospital Affiliated to Southeast University, said that to prevent juvenile lumbar protrusion, schools, teachers and parents must form a joint force to ensure that students have time for recess activities and avoid children from sitting for a long time.

Wang Pingzhi suggested that in view of the current new situation of high lumbar pressure among teenagers, the physical education curriculum of primary and secondary schools and the physical examination items of the high school entrance examination should be optimized, and the training of the cervical spine and lumbar spine should be strengthened in a targeted manner, such as including abdominal curls and planks. At the same time, it is necessary to pay attention to the scientific nature of physical training, avoid the test-oriented physical education, and make it gradual and orderly to avoid lumbar spine injuries caused by unscientific exercise.

Considering the risk to students' health caused by the incompatibility of desks and chairs, a number of experts suggested that relevant financial investment should be increased in a timely manner to promote the use of adjustable desks and chairs, and at the same time, relevant supervision and inspection should be strengthened to ensure that the height of desks and chairs is dynamically adjusted according to the height of students, so that each student has a set of "fit" desks and chairs. In addition, some schools have purchased reclining tables and chairs, opened napping areas, etc., to avoid lumbar spine injuries caused by sleeping on their stomachs, which is worth learning.

In the interview, the reporter found that many parents and teachers do not think that their children will get lumbar protrusion, and they are negligent in preventing this and lack effective response.

Some clinicians said that after some teenagers have symptoms of low back and leg pain, some parents do not go to a regular hospital for treatment as soon as possible, but go to a nearby small clinic or Chinese medicine hall for massage, which may aggravate the condition. Experts suggest that the knowledge of lumbar spine diseases in adolescents should be strengthened, and a dense protection network should be woven for the health of adolescents.