Let's look at an example
Young guy in the city, 20 years old, college student, good at playing basketball. After a ball play, feel the waist sore and uncomfortable, think that they are tired of playing ball, there is no care, the next morning up waist pain did not alleviate, and there is left leg pain numbness, consciously the groin also has numb pain feeling, because in the school to go to class, there is no time to see a doctor, buy some painkillers and plasters, after three days the pain is not reduced, but the pain in the lower limbs is aggravated significantly, and at the same time there is a urinary sensation abnormality, if you feel that the urine can not be strong, at the same time the stool is also abnormal. Walking is a bit lame, taking advantage of the weekend roommate to help go to the school hospital to see a doctor, there is no examination equipment in the school hospital. Usually also look at a cold cough, less contact with these diseases, there is no clear diagnosis, consider is playing ball when the lumbar sprain, hanging for two days of water, painkillers and blood activating stasis drugs, waist pain is alleviated a little, but the left leg pain is not improved, and the urinary and urinary function is abnormally aggravated, consciously saddle area numb discomfort, feel that they are not right, told the parents, parents are also worried about the child, just drove over, the nearest orthopedics in our hospital, I received the treatment, asked the situation.
Patients with low back pain with left lower extremity pain after playing ball, numbness in the saddle area, urinary and urine dysfunction, physical examination can be seen: lumbar muscle stiffness, positive upright abdominal test, straight leg elevation test positive left leg, left lower limb muscle strength level 4, lower extremity pathological reflex weakened, saddle area examination cremasteri reflex weakened. Considering lumbar disc herniation, I gave him a LUM examination, and the results suggested the following: Lumbar 4-5 disc herniation with prolapse.
Red is the protruding disc, green is normal
The upper MRI can see that a large black thing in the red area is the protruding disc, and the two green areas below, the spinal canal inside are all white areas, and there is no protruding disc. Patients with lumbar 4-5 intervertebral disc herniation, compression of lumbar 5 nerve roots and spinal cord, lumbar 5 nerve compression will appear lower limb posterior lateral pain numbness, prolapsed nucleus pulp caused by spinal cord compression appears cauda cauda equina syndrome symptoms, resulting in urinary and urinary dysfunction.
Tell patients and families. Now it is a severe herniated disc, there is an abnormal function of urinary and urinary stool, and it is necessary to hurry up for surgery to avoid nerve compression for a long time and irreversible damage.
The family is now worried about several issues. The first is that the child is still young, and there is no object yet. At this time, the lumbar spine surgery will not affect the future life, the second is that the folk are rumored to have lumbar spine surgery if it touches the nerves, I am afraid of surgery.
I gave my family three options, the first of which was to start surgery, direct posterior partial resection of the lamina, spinal canal decompression and discectomy together, so that young people don't have to hit nails. But there are about five or six centimeters of openings in the back, and you have to sew a few stitches.
The second is minimally invasive surgery, radiofrequency ablation, but now that it is prominent, radiofrequency ablation may not be completely eliminated.
The third is now more popular, lumbar spine mirror surgery, about to cut a 0.7 cm opening, through a cannula with an endoscopic system, in the visual conditions to remove the protruding disc nucleus, without stitches, less trauma, fast recovery.
The family asked to go home and discuss it, and I knew their concerns, so I said it. You take the film to the major hospitals in the city to consult and then make a decision.
On the third day, the patient was still helped by his family and asked to be hospitalized for minimally invasive endoscopic surgery, saying that they asked many hospitals to ask for surgery, the sooner the better, told me almost the same, but some of their hospitals do not have endoscopic surgery systems. Some hospitals can not see the small surgery, requiring to do pioneering surgery, the final result is still in our hospitalization, did lumbar spine microscopy surgery, intravenous anesthesia with nerve block anesthesia, surgery in the C-arm machine perspective operation, an hour ends, take out a piece of about 2.0 times 0.8 nucleus pulposus, microscopic nerve compression relief, wake up after the patient can feel the pain of the lower limbs at that time, the next day feel the improvement of urinary and urinary function, three days later to improve discharge, we continue to follow up.
Endoscopic surgery, all through this tube
Today we come to study lumbar disc herniation, which is also my specialty, the combination of traditional Chinese medicine and Western medicine to treat neck, shoulder, waist and leg pain.
The intervertebral disc is located between two adjacent vertebral bodies and consists of two parts, the inside and the outer parts. The inside is the nucleus pulposus, which is elastic and has the effect of mitigating impact; on the outside is a ring-like arrangement of fibrochondrite rings, which can prevent the nucleus of the medulla from protruding outward.
Lumbar disc herniation is a group of diseases that cause degenerative changes in lumbar discs, rupture of fibrous rings, and herniation of the nucleus pulposus for various reasons. When the lumbar disc herniation compresses the nerve, corresponding lumbar and leg symptoms may occur, and the diagnosis is lumbar disc herniation.
pathogen
Internal causes: congenital development of the lumbar spine, lumbar disc congenital development defects, resulting in lack of blood supply in the intervertebral disc, poor repair ability.
External causes: due to long-term exertion injury, female pregnancy, or trauma, the lumbar muscles, ligaments, and intervertebral discs are under excessive load for a long time, and corresponding degeneration occurs.
Lumbar degeneration: mainly caused by long-term wrong lifestyle, such as sitting, long-term bending to extract heavy objects, etc., can lead to degenerative intervertebral disc herniation, thereby compressing nerve roots, waist and leg pain.
Genetic factors: the disease may be genetically related, and there are reports that the disease has familial onset, but corresponding data are still lacking.
Checks that need to be done
X-ray of the lumbar spine: X-ray examination can assist in judging lumbar disc herniation and assessing vertebral instability, and is the simplest and most economical examination method. Although the detection rate is only 60%, it can be judged whether there are diseases such as tuberculosis and tumors at the same time.
CT examination: it can clearly show the location, size, morphology, nerve roots, and dural sac compression displacement of the disc herniation, as well as the hypertrophy of the lamina and ligament flavum, joint hyperplasia, spinal canal and lateral crypt stenosis.
Magnetic resonance imaging (MRI): MRI can comprehensively observe the situation of lumbar disc lesions, through different levels of sagittal surface imaging and intervertebral disc transection images, can clearly show the shape of intervertebral disc herniation and the relationship between surrounding tissues such as dural sac and nerve roots, and identify whether there are other mass lesions.
drug therapy
Common drugs: ibuprofen, clozoxazin, mannitol
Nonsteroidal anti-inflammatory analgesics, such as ibuprofen, diclofenac, meloxicam, celecoxib, etc., can relieve pain. Common adverse reactions are epigastric discomfort, vague pain, nausea, vomiting, headache, dizziness, tinnitus, etc.
Muscle relaxants: those with muscle cramps can use muscle relaxants, such as clozosacin. The adverse reactions of clozasadine are mainly gastrointestinal symptoms such as nausea, followed by nervous system reactions such as dizziness, dizziness, and drowsiness. It is generally mild and can disappear on its own or be relieved after discontinuation.
Dehydration agents: Dehydrating agents such as mannitol may be used when neuroedema is considered. Mannitol is contraindicated in patients with severe dehydration, intracranial active hemorrhage, acute pulmonary edema, and severe pulmonary stasis.
Glucocorticoids: Short-term use of glucocorticoid drugs can effectively relieve inflammation-responsive pain. People who use glucocorticoids in large doses should not become pregnant, and pregnant women should use glucocorticoids with caution.
Surgical treatment
Minimally invasive surgery: including foraminoscopy and discoscopy. It has the advantages of less trauma and fast recovery.
Surgery: If disc degeneration is complicated by spinal instability, traditional surgical surgery, including a combination of pedicle nail fusion techniques and decompression techniques, may be preferred.
This is a lumbar spine nail, look good
This is the lumbar internal fixation surgery that many hospitals are doing
Conservative treatment
Patients with lumbar disc herniation should first take conservative treatment, bed rest, and generally bed rest for 3-4 weeks can mostly alleviate symptoms.
Other treatments
Nerve block technology: If the effect is not obvious after more than three months of conservative treatment, the nerve block technique can be selected. Block the nerves through local anesthetics and anti-inflammatory drugs to achieve the purpose of treatment.
Daily care is required
Pay attention to the correct sitting posture when working, and adjust it regularly. Avoid working on desks for long periods of time, and if you need to sit or stand for a long time, you should change your position frequently. Between work, you can get up and move a small number of times.
Use a chair that provides appropriate back support, and adjust the office chair frequently to avoid sitting in the same position for long periods of time. At the same time, avoid bending down to lift heavy objects, you should squat down when you need to bend, and you should also avoid driving for a long time.
Usually, you should avoid waist colds, and prefer a mattress with moderate hardness when sleeping at night.
For patients who require bed rest to relieve severe symptoms, a return to moderate normal activity should be returned as soon as possible after symptoms improve.
When working continuously or in some special cases that will aggravate the load on the spine, you can wear waist protectors appropriately, but pay attention to relaxing the protective gear regularly.
Patients with excessive BMI should lose weight, it is recommended to maintain a BMI below 25, and patients who smoke should quit smoking.
Strengthen your workouts and strengthen your body. Exercise strengthens bones and lower back muscles and stabilizes the lumbar spine.
Lumbar spine exercises
Maintain the correct working posture.
Sedentary workers and heavy lifters can use a wide belt or waist circumference to strengthen waist stability. In daily activities and work, care should be taken not to suddenly turn the body when bending over.
Avoid wind chills and pay attention to keeping your waist warm.
Avoid heavy physical labor during pregnancy and lactation, and pay attention to rest.
Interpret from the perspective of Chinese medicine
Low back pain refers to a type of disease in which the waist feels external evil, or due to strain, or kidney deficiency caused by dysfunction of qi and blood, tingling of the veins, and loss of waist, with pain on one or both sides of the waist as the main symptom.
Low back pain can occur all year round, its incidence is high, foreign reports that 80% of the world's population has suffered from low back pain, this disease is one of the more common diseases in the internal medicine clinics of traditional Chinese medicine, and traditional Chinese medicine has a better effect.
Rheumatic low back pain, lumbar muscle strain, and low back pain of spinal lesions in Western medicine can be treated with reference to this section.
【Etiology】
1． The invasion of foreign evils is mostly caused by the dampness of the living place, or the sweat of labor, the wind, the cold and wet clothing, or the cold in the rain, or the long summer season, the labor in the place where the damp and hot steam, the cold and wet, the humid heat, the summer heat and other six adulterous evil poisons take advantage of the weakness of labor, invade the waist, causing the waist meridians to be blocked, the qi and blood are not smooth and the waist pain occurs. If the cold and evil are sick, the cold hurts the yang, the lord receives the introduction, the yang qi of the waist is both weak, and the veins are suppressed and the waist pain is born. If the wet evil is a disease, the wetness is heavy, sticky, downward trend, and the stagnation of the qi machine can make the waist depressed and not good, and the blood network is not smooth, so that the muscles and veins are tight and the waist pain is issued. Feel the evil of damp heat, heat hurt yin, wet hurt yang, and damp heat sticky, curb the meridians, qi and blood depressed and not walk and waist pain.
2． Qi stagnation, blood stasis waist continue to exert force, too much labor, or long-term improper posture, or improper waist force, qi flash setbacks, fall servant trauma, strain waist tendons and pulse qi and blood, or long patient network, poor operation of qi and blood, can make the waist qi machine stagnation, blood stasis and waist pain.
3． Kidney deficiency congenital endowment is insufficient, coupled with too much fatigue, or long-term illness and weakness, or old age, or atrioventricular irregularities, so that the kidney essence loss, can not nourish the waist and veins and low back pain occurs. Successive generations of doctors have attached great importance to kidney deficiency is an important mechanism for low back pain. For example, the "Lingshu Wuyi Jin Liquid Farewell" said: "Emptiness, so the back is painful and shiny." "Jingyue Quanshu Waist Pain" also believes: "The false evidence of low back pain is ten to eight or nine." ”
The waist is the house of the kidneys, the realm of the essence of the kidneys. The kidneys and bladder are in the surface, and the foot sun passes through it. In addition, Ren, Supervisor, Chong, and Belt are also distributed in between, so internal injuries are not external kidney deficiency. And the external feeling of wind cold, damp and hot evils, with wet viscosity, wet flow, the most likely to paralyze the waist, so the external feeling is always inseparable from the wet evil. The two internal and external causes affect each other, such as "Miscellaneous Disease Source Flow Rhinoceros Candle • Low Back Pain Source Flow" pointed out: "Waist pain, lack of essence and evil guest disease also." ...... Kidney deficiency of its origin, wind cold, damp and hot phlegm drinking, qi stagnation and blood stasis flashing its standard also, or from the standard, or from the original, expensive and appropriate. "It shows that kidney deficiency is the key to the onset of the disease, the paralysis of wind and cold, dampness and heat is not good, often because of kidney deficiency, otherwise although it feels evil, it will not cause waist pain." As for labor sprains, they are related to blood stasis and are not uncommon clinically.
Divide the evidence
Cold and wet low back pain
Symptoms: waist cold pain is heavy, turning side unfavorable, gradually aggravated, every rainy day or waist cold after aggravation, pain like temperature, heat is reduced, moss white and greasy and moist, pulse tight or late.
Treatment: disperse cold and dehumidify, warm meridians.
Prescription: seepage soup.
Damp heat back pain
Symptoms: flaccid lumbar hip pain, impatience, pain with heat, pain after heat in the summer or waist, cold pain alkali,
Thirsty and unwilling to drink, yellow and red urine, or hot in the afternoon, slightly sweaty, red tongue and yellow moss, pulse number or string number.
Treatment: clear heat and dampness, relax muscles and vitality.
Prescription: Flavored ermiao.
Bruising and low back pain
Symptoms: the sore area is fixed, or the swelling pain is uncomfortable, or the pain is like a cone prick, day and night heavy, or persistent, unfavorable movement, even can not turn sideways, the pain point refuses to press, the face is obscure lips, the tongue is cryptoclyped or ecchymotic, and the pulse is astringent or fine. The course of the disease is prolonged, and there is often a history of trauma and strain.
Treatment: activate blood and dissolve stasis, rationalize qi and relieve pain.
Prescription medicine: body pain and stasis soup.
Kidney deficiency and low back pain
Symptoms: Low back pain is mainly sour and soft, like to rub, legs and knees are weak, in case of labor, lying down is alleviated, often repeated attacks. Those with partial yang deficiency are less anxious, pale, hands and feet are not warm, less qi and weakness, and the tongue is light and thin; those who are partially yin and weak are upset and insomnia, dry mouth and throat, flushed face, hot hands and feet, red tongue, and fine pulse strings.
Treatment: For those who are partial to the yang, it is advisable to warm up the kidney and yang; for those who are partially yin and weak, it is advisable to nourish the kidney yin.
Prescription medicine: For those who are partial to the yang deficiency, the right return pill is the main party to warm the fire of the life gate. Fangzhong uses cooked land, yam, dogwood, and goji berries to cultivate kidney essence, which is used for seeking yang in the yin; Eucommia is strong and strong; Silkworm seed is used to supplement the liver and kidneys; angelica tonifies blood. The combination of various medicines plays the role of warming the kidneys and strengthening the waist.
Those with partial yin deficiency take zuo gui pill as the main remedy to nourish the kidney yin. Fangzhong ripe land, goji berries, dogwood, turtle plate glue to fill the kidney yin; with silk seeds, staghorn gum, beef knee to warm the kidney waist, kidney nourishment can be removed. If the fire is even worse, you can take the yin pill as appropriate. If the low back pain does not heal for a long time, there is no obvious yin and yang deficiency, you can take Qing'e pills to supplement the kidneys to treat low back pain.