Etiology of lumbar disc herniation: Workers who have been sitting in a sitting position without changing their posture or who have been engaged in manual labor for a long time or who have been in a cold and humid environment for a long time, the muscles and bone tissue of the waist are deformed under excessive fatigue, and the disc tissue is squeezed out of its original position, so lumbar disc herniation naturally occurs, which is the first cause of lumbar disc herniation: long-term lumbar muscle strain. The second reason is that the lumbar intervertebral disc is protruded by external force. In addition to the above two reasons, Chinese medicine also believes that some friends with kidney deficiency, calcium deficiency, wind, cold and dampness are also prone to lumbar disc herniation.

In other words, the common inducing factors are:

① Increased abdominal pressure, such as severe cough and forced defecation during constipation.

② When the waist posture is improper and the waist is in flexion position, sudden rotation is easy to induce nucleus pulposus protrusion.

(3) Sudden load, in the absence of adequate preparation, suddenly increase the waist load, which is easy to cause nucleus pulposus protrusion.

(4) Lumbar trauma, acute trauma can spread to fibrous ring, cartilage plate and other structures, and promote the degeneration of nucleus pulposus protrusion.

⑤ Occupational factors, such as long-term sitting and bumping, are easy to induce disc herniation.

2. Clinical manifestations: The main symptoms of patients with lumbar disc herniation are low back pain and sciatica. Because the waist is the hinge of human activities and bears great compressive stress and torsional stress, the lumbar intervertebral disc is most prone to degeneration and rupture. Under the action of external factors such as slight lumbar sprain or feeling cold and dampness, disc herniation occurs. About half of the patients showed low back pain first, then leg pain, and about 65,438+0/3 patients had low back pain and leg pain. For patients with low back pain, the pain lasts for several days, and for the elderly, it can last for several years. Most of them are in the lower back and lumbosacral region. This kind of pain is deeply felt, manifested as localized or extensive dull pain in the back, slow onset, inaccurate positioning, aggravated during exercise and relieved after bed rest.

About 98% patients with lumbar disc herniation have leg pain symptoms. The location and nature of pain vary with the position of disc herniation. 95% of lumbar disc herniation occurs in the intervertebral disc of lumbar 4, 5 or lumbar 5, 1. Therefore, most of these patients mainly show radiation pain along the sciatic nerve of one or both lower limbs. Most patients have pain along the hip to the back or outside of thigh, the outside of calf to heel or toe, and some patients may start from the outside of calf or ankle. The range of pain is related to the degree of nerve root contact with the herniated intervertebral disc. Half of the patients may suffer from cough, sneezing or abdominal exertion. Patients may have lower limb pain and allergy in the early stage, and those with longer course of disease or severe nerve root compression may have numbness or insensitivity of lower limbs. For patients with high lumbar disc herniation, the symptoms are mostly pain in groin area of lower abdomen or anterior and medial thigh.

Patients with central disc herniation may have abnormal urination or incontinence, numbness in the saddle area, and even foot drop in severe cases. Some patients with lumbar disc herniation have lower limb fever due to the stimulation of their lumbar sympathetic nerves, and some may also have unilateral or bilateral lower limb edema. The typical signs of patients with lumbar disc herniation are lumbar muscle spasm, protective lumbar scoliosis, limited lumbar movement (mainly flexion), paravertebral tenderness, limited straight leg elevation and so on. Don't panic when you have the above symptoms and signs and think it may be lumbar disc herniation. For lumbar disc herniation, as long as it is diagnosed as soon as possible and treated in the right way at an early stage, satisfactory results can generally be achieved.

In addition, the incidence of high lumbar disc herniation is less, and the incidence is mostly low back pain and big leg pain. Lumbar intervertebral disc protrudes in the center of spinal canal, and the patient suddenly has severe pain in perineum, dysuria, sexual dysfunction or weakness of lower limbs, which is cauda equina syndrome and should be treated immediately.

3. Current conventional treatment methods and misunderstandings:

1), drug therapy: taking medicine, injection and sticking plaster all belong to drug therapy. Drug therapy mainly has the functions of diminishing inflammation and swelling, relieving pain, promoting blood circulation and removing blood stasis, mainly including aspirin, indomethacin, ibuprofen, fenbid, antongding, voltarin (antipyretic, analgesic and anti-inflammatory drugs), tramadol, indomethacin, dolantin and Tonglike (analgesic drugs). Vitamin B 1, B 12, E, C, adenosine triphosphate, inosine (vitamins and nutritional drugs), central muscle relaxants, diuretics and dehydrating drugs. As far as the pathogenesis of lumbar disc herniation is concerned, drug treatment is not a permanent cure, but can only relieve symptoms and temporarily relieve the pain of patients, and the effect will be obvious in the early or acute stage of the disease. However, all drugs have different degrees of toxic side effects, so it is not suitable for long-term use. It can only play an auxiliary role. As can be seen from the picture on the right, the blood circulation of adult lumbar intervertebral disc has been blocked due to years of oppression, and the nutrition supply mainly depends on the surrounding soft tissue, so it is difficult for drugs to enter the intervertebral disc, so it can not play a therapeutic role, and can only play an anti-inflammatory and analgesic role in the surrounding soft tissue.

Therefore, drug treatment is bound to be a long-term investment, endless, often drug-induced patients, see the light but not the good, take temporary solution instead of permanent cure.

2) Physical therapy: Patients with lumbar disc herniation will have a history of pain for some time. Because the symptoms are mild at first, many people are used to using massage to relieve pain when they are in pain. In fact, massage can only promote blood circulation, remove blood stasis and relieve pain, but can't eradicate the root cause. Moreover, many people who massage and massage lack sufficient medical knowledge about lumbar disc herniation, which often aggravates the condition and even causes accidents. Therefore, experts suggest that doctors who choose to implement massage treatment should first understand the incidence and treatment mechanism of lumbar disc herniation, otherwise it will easily lead to accidents. Others, such as acupuncture, electrotherapy, cupping, laser, ultrasound, paraffin therapy, etc. All of them are mainly anti-inflammatory and analgesic, promoting blood circulation and removing blood stasis, and it is difficult to treat the symptoms.

3) Blocking therapy: Injecting drugs around pain points and nerve roots is called blocking therapy. Mainly plays the role of improving blood circulation, diminishing inflammation and relieving pain.

4) Nucleolysis: 1964, American medical doctor Smith used papaya to dissolve the nucleus pulposus and injected protease into the protruding intervertebral disc for the first time, which accelerated the degeneration of the intervertebral disc, made it dehydrated and fibrotic, and reduced the pressure on nerve roots. This therapy is a kind of therapy at the cost of accelerating intervertebral disc degeneration, which will not restore the original function and has obvious side effects.

5) Traction therapy: Traction is one of the most effective measures to treat lumbar spondylosis. Through the principle of mechanical force and reaction force, the lumbar spine is pulled to widen the intervertebral space, so as to achieve: a, to reduce the pressure on the intervertebral disc, to promote the retraction of the intervertebral disc, and to reduce the stimulation and oppression on nerve roots and other tissues. B, eliminate inflammation and promote blood circulation. C, relieve muscle spasm and improve local blood circulation. The traditional traction method is carried out on the bed, which can only be carried out intermittently once a day. Every time a patient gets out of bed and goes home or goes to work, the recovered nucleus pulposus will be compressed again under the pressure of upper body gravity, resulting in all previous efforts being wasted and repeated attacks.

6) Surgical treatment: mainly used for those who seriously affect their life, work and rest, and those who are ineffective in non-surgical treatment. Surgery has changed the original tissue structure of human body and belongs to trauma therapy. The patient is in more pain. Surgery destroys human tissues, leading to changes in human tissue structure, which is easy to aggravate the lesions of other tissues. For example, some patients, after a period of operation, are easy to cause degeneration of other lumbar intervertebral discs or cause swelling or protrusion in different degrees, and are also easy to produce nerve adhesion or numbness of legs and feet, and lose consciousness, especially easy to cause hyperosteogeny or vertebral instability. So surgical treatment can only be used as a last resort. Lumbar disc herniation is a self-limiting or self-healing disease to some extent. About 80%-90% patients can get satisfactory curative effect through non-surgical treatment, and only 10%-20% patients need surgical treatment. Non-surgical treatment should be the first choice for lumbar disc herniation except for patients with persistent cauda equina nerve damage. But in recent years, in order to pursue profits, some hospitals prefer surgical treatment. This overtreatment not only wastes valuable medical resources, increases patients' pain and economic burden, but also leads to a high incidence of surgical failure, which should be paid attention to.

According to statistics, after surgical treatment, 2 1.5%-40% patients still have different degrees of low back and leg pain. Foreign scholars have observed the curative effect of lumbar discectomy in adolescents. During the 45-year follow-up period, 20 of 72 cases, that is, as high as 28%, needed reoperation. Foreign experts have made a lot of literature review and analysis on indications, methodology and complications of surgical resection of lumbar disc herniation. They found that although patients with lumbar disc herniation can remove the herniated disc and enlarge the narrow nerve root canal after surgical treatment, the short-term effect is remarkable, and the excellent and good rate of surgery can reach 75%-95%, but the long-term effect is not much better than non-surgical treatment and natural course of disease. Surgery can't eliminate the root cause of lumbar process.