The treatment of lumbar disc herniation help to say some good?

What is lumbar disc herniation

After puberty, various tissues of the human body will have degenerative changes, in which the changes of the intervertebral disc will occur earlier, the main change is the dehydration of the nucleus pulposus (NP), and after the dehydration, the intervertebral disc will lose its normal elasticity and tension, and based on this, due to the heavy trauma or repeated repeated inconspicuous injuries, resulting in the fibrous annulus is weak or ruptured, and the nucleus pulposus (NP) is protruded from the place. The nucleus pulposus mostly protrudes into the spinal canal from one side (a few can be on both sides), compressing the nerve root and producing signs of nerve root injury; it can also protrude backward from the center, compressing the cauda equina nerve and causing urinary and defecation disorders. If the annulus fibrosus is completely ruptured, the broken nucleus pulposus tissue enters the spinal canal, which can cause extensive cauda equina damage. Because of the heavy load on the lower lumbar region and the many activities, the herniation occurs mostly in the lumbar 4-5 and lumbar 5-sacral 1 interspace.

Clinical manifestations

(a) low back pain and one side of the lower extremity radiating pain is the main symptom of the disease. Lumbar pain often occurs before leg pain, or both at the same time; most of them have a history of trauma, or no clear cause. The pain has the following characteristics: 1, radiating pain along the sciatic nerve conduction, directly to the lateral calf, the dorsum of the foot or toes. 2, all the actions that increase the pressure of cerebrospinal fluid, such as coughing, sneezing and defecation, can aggravate the lumbar pain and radiating pain. 3, the pain intensifies with activity and decreases with rest. Bed position: most patients adopt the lateral position, and flex the affected limbs; individual severe cases in various positions are painful, can only flex the hip and knee kneeling on the bed to relieve the symptoms. In combination with lumbar spinal stenosis, there is often intermittent claudication.

(2) scoliosis: the main curvature in the lower lumbar, forward bending is more obvious. The direction of scoliosis depends on the relationship between the protruding nucleus pulposus and the nerve root: if the protrusion is located in front of the nerve root, the trunk usually bends to the affected side.

(3) limited spinal activity The herniated nucleus pulposus compresses the nerve root, causing the lumbar muscles to show protective tension, which can occur unilaterally or bilaterally. Because of the lumbar muscle tension, the lumbar vertebrae physiological anterior convexity disappeared. Spinal forward flexion and backward extension activities are restricted, and radiating pain to one side of the lower limb may occur during forward flexion or backward extension. Lateral bending restriction is often only on one side, according to which it can be identified with lumbar spine tuberculosis or tumor.

A comparison of the advantages and disadvantages of various treatments for lumbar disc herniation

I. Drug treatment

Drug treatment includes therapeutic drugs and symptom-relieving drugs. Due to the special structure of the lumbar intervertebral disc, it is difficult to cure a lot of general drugs, so the general western drugs only play the function of pain relief, relieve the clinical symptoms of the main. Because the lumbar disc blood supply is inherently insufficient, the disc annulus fibrosus is basically no blood supply, intravertebral disc nutrition on the upper and lower cartilage plate penetration is the main, so the general internal medicine for lumbar disc herniation has no therapeutic effect, can only achieve anti-inflammatory and pain relief of the temporary effect. Can not achieve the purpose of lumbar herniation. Only with traditional Chinese herbal medicine with valuable animal drugs and mineral drugs to achieve satisfactory results. Traditional Chinese medicine using modern scientific formulas by modern high scientific research clinically verified herbs can easily penetrate the disc bone, directly to the lesion, so that the nucleus pulposus of the intervertebral disc dehydration and atrophy, dissolution of the nucleus pulposus and achieve a satisfactory cure for the purpose. Therefore, Chinese medicine is currently the most ideal treatment for spondylolisthesis.

Second, traction therapy

We all know that lumbar disc herniation is divided into three types of bulging, protruding and prolapsing with the size of the protrusion. To the severity of clinical symptoms in the acute and remission period, lumbar disc herniation patients, in the first onset of general hospitals are recommended that patients first use traction therapy, traction is mainly mechanical strength to pull the intervertebral space, and reduce the internal pressure of the intervertebral disc, so that the protruding material on the nerve compression is slightly reduced from the theoretical is relatively correct, but the clinical effect of the treatment is indeed less than ideal. This is mainly due to the fact that the strength of traction varies from person to person, and it is difficult to hold; another is that it is difficult to accurately differentiate the selection of indications; and then it is the problem of patient's cooperation. For patients with lumbar bulging discs, the pressure within the disc is very high, which can be cured by traction, but it is more ideal to stay in bed during traction. If you walk or ride in a car immediately after traction, the high pressure in the intervertebral disc will be restored, resulting in the ineffectiveness of traction. Traction is only applicable to patients with bulging discs. If the disc has herniated and prolapsed, traction is completely ineffective and may aggravate the patient's symptoms. In the acute phase of lumbar disc herniation, traction is contraindicated. Because the patient in the acute stage, due to the edema of the nerve root and inflammation stimulation, will cause the lumbar back muscle tension, spasm, if this time traction will strain the lumbar muscle fibers, resulting in lumbago and aggravate the clinical symptoms. To summarize, traction is only suitable for patients with simple lumbar disc bulging, and must be used when the symptoms are not serious, to relieve clinical symptoms for the purpose of prohibiting lumbar disc herniation, prolapse, accompanied by spinal stenosis, and lumbar protuberance in the acute stage of the patient.

Three, physical therapy, massage therapy, acupuncture

Physical therapy includes electrotherapy, infrared irradiation and other methods, and massage, acupuncture and other treatment purposes are basically the same. It is to relieve the patient's clinical symptoms, rather than a cure. Because most patients with lumbar herniation are accompanied by chronic lumbar muscle strain, pear-shaped muscle tension, lumbar disc herniation compression of the nerves with the nerves through the parts of the muscle spasm caused by lumbar and leg pain, the general hospital will use physical therapy, massage, acupuncture and other treatment means to relieve muscle tension and spasm. So patients who have had physical therapy know that they will feel better when they have physical therapy and will be the same as before when they don't. That's why physical therapy, massage, acupuncture and other treatments are only used in conjunction with lumbar synostosis.

Four, closed therapy

Closed treatment is divided into two application methods, one for the spinal canal closed, a nerve root closed. As the name suggests, intrathecal closure is directly injected with drugs into the spinal canal, and nerve root closure is to inject drugs around the nerve root. The injected drugs are mainly adrenal glucocorticoids plus local anesthesia. Under the action of hormone, it can reduce and eliminate the aseptic inflammation and edema of the nerve root; anesthesia drugs are for pain relief, anesthetizing the nerve to make it less sensitive. We all know why lumbar herniation can lead to low back pain, mainly due to the nucleus pulposus of the lumbar intervertebral disc compression of the nerves after the nerve root edema and aseptic inflammation, so the effect of the closure is to stop the pain, the protrusion compression can not be resolved when the closure of the drug effect is over the symptoms of low back pain and immediately back again.

Fifth, needle knife therapy

Needle knife therapy that is small knife (its water knife that is small knife), small knife therapy is in acupuncture and closed therapy on the basis of the development of a new treatment method, in recent years, gradually "deified" its therapeutic effect. Small needle knife is a surgical instrument with a needle knife, in the pain points of patients with low back and leg pain on a wide range of peeling and loosening, and then injected into the local anesthetic drugs and hormone drugs, to play the role of anti-inflammatory and pain relief, the purpose of the small needle knife is to expand the scope of the closure of the creation of conditions, so the small needle knife treatment in fact, is a closed treatment of the improvement of the therapeutic effect of the closure of the same. Since adrenal glucocorticoid hormone is used in the treatment process, it should not be used more than once. Side effects of hormones can cause such as osteoporosis, gastrointestinal reactions, acne hairy, centripetal obesity, etc., and at the same time accompanied by diabetes mellitus, hypertension and other patients prohibited.

Six, surgical treatment

1, conventional open surgery:

Conventional open surgery includes: total laminectomy, hemilaminectomy, transabdominal disc surgery, vertebral body fusion. The purpose of the surgery is to directly remove the nucleus pulposus of the diseased lumbar intervertebral disc and relieve the nerve root compression to achieve the therapeutic purpose. Due to the special physiological position of the lumbar spine, the surgery destroys the normal physiological structure of the lumbar vertebrae, resulting in large surgical injuries, which is easy to cause postoperative instability of the lumbar vertebrae, postoperative adhesion of scar tissues, and a series of adverse reactions such as accidental injury to the nerve root during the surgery, so most of the patients are afraid of the surgery, and how to avoid the above adverse reactions caused by the surgery? This has been a major problem in the medical community.

2, discoscopy minimally invasive surgery

In order to avoid the big damage problem of conventional open surgery, reduce the risk of surgery and complications, in microsurgery and arthroscopy assisted lumbar disc surgery, although it is a reduction of the damage to the normal bone and joints in the course of the operation, but the minimally invasive surgery is the same as the surgery, there are surgical risks and complications, the other most important problem is that after the surgical field becomes smaller, it is difficult to avoid the risk of injury to the nerve root during the operation. Another major problem lies in the fact that it is difficult to remove the nucleus pulposus (NPS) of a diseased lumbar disc cleanly and completely after the field of view of the surgery has become smaller, which increases the risk of the surgery being unsuccessful.

3, percutaneous puncture suction:

Most patients with lumbar disc herniation have herniation due to increased pressure within the intervertebral disc. Percutaneous puncture and cutting suction can significantly reduce the intravertebral disc pressure and the content of the herniated disc, thus reducing or eliminating the compression symptoms of the herniated material on the nerves. The advantage of this method is that there is less damage during the procedure, but the disadvantage is that the procedure is based on decompression, which is effective for bulging discs, and is contraindicated for the types of lumbar herniation such as prolapse, free, and combined calcification, which results in a too narrow surgical surface.

Seven, collagenase chemical dissolution therapy

The human intervertebral disc nucleus pulposus tissue, consisting of water, fibrous tissue, proteoglycans, collagenase, collagenolytic enzymes, can dissolve nucleus pulposus proteoglycans, but the human body has a tendency to be allergic to proteins and enzymes, this allergy has a life-threatening danger, so the use of this therapy has been banned in foreign countries; furthermore, the collagenase dissolution therapy if the Failure, it will be in the disc inside and outside the formation of extensive scarring adhesions, to the subsequent treatment brings difficulty, at present, China's hospitals of all sizes basically use collagenase, using the method of treatment of lumbar synostosis.