Treatment of lumbar disc herniation

There are non-surgical and surgical treatments for lumbar disc herniation. Patients choose different treatments for different pathological stages and clinical manifestations as well as different physical and psychological conditions, which should be judged according to the indications at that time.

I. General treatment

1. Bed rest: patients must stay in bed until the symptoms are completely relieved. Generally need to be bedridden for 3 weeks, 3 weeks after wearing a girdle to get up and move around. 3 months, do not do bending over to hold the action.

2, continuous traction: the purpose of traction is to reduce the pressure on the intervertebral discs, prompting the nucleus pulposus to varying degrees of retraction; traction can be relieved of lumbar spine after the joints of the load, and at the same time can be relieved of muscle spasm. Commonly used traction types are manipulative traction, pelvic traction and so on.

3, physical therapy massage and massage: this method can reduce the pressure of the intervertebral disc, can make the spasm of muscle relaxation.

Two, drug treatment

1, oral non-steroidal anti-inflammatory analgesics: in the absence of contraindications, the first to consider non-steroidal anti-inflammatory analgesic drugs, such as ibuprofen extended-release capsules, meloxicam, etc..

2, muscle relaxants: accompanied by muscle spasms can be used muscle relaxants, such as chlorzoxazone, tizanidine and so on.

3, dehydration: if there is nerve edema can be used in the presence of mannitol and other dehydrating agents.

4, glucocorticoids: short-term use of glucocorticoids can be used when there are no contraindications, which can effectively relieve inflammatory response pain.

Three, surgical treatment

1, surgical indications:

(1) lumbar and leg pain symptoms are serious, recurring, after more than half a year of non-surgical treatment is ineffective, and the condition is gradually aggravated, affecting the work and life.

(2) Central type protrusion with cauda equina syndrome and sphincter dysfunction should be operated as an emergency.

(3) Those with obvious manifestations of nerve involvement.

2, conventional open surgery: including total laminectomy, hemilaminectomy, intervertebral disc removal surgery, vertebral fusion, etc., the purpose is to directly remove the nucleus pulposus of the diseased lumbar intervertebral disc, to relieve the nerve compression and achieve the therapeutic purpose.

3, intervertebral foramenoscopy minimally invasive surgery: in order to avoid the problem of conventional open surgery damage, reduce the risk of surgery and complications, in the microsurgery and arthroscopy assisted lumbar disc surgery, reducing the damage to the normal bone and joints in the course of the operation, but the method makes the surgical field of view becomes smaller, it may be difficult to clean and completely remove the nucleus pulposus of the diseased lumbar intervertebral disc.

4, percutaneous puncture and suction: can significantly reduce the internal pressure of the intervertebral disc, reduce the content of the protruding disc, thereby reducing or eliminating the protruding material on the nerve compression symptoms.

Four, other treatments

1, pain point closure therapy: lumbar lumbar intervertebral disc herniation patients with a clear limitation of pressure pain, commonly used 2% procaine or 2% lidocaine to implement the pain point closure.

2, nucleus pulposus chemical dissolution: collagenase is injected into the intervertebral disc, or injected into the dura mater and the herniated nucleus pulposus. The enzyme can selectively dissolve the nucleus pulposus and the annulus fibrosus without damaging the nerve root, so that the internal pressure of the intervertebral disc can be reduced and the protruding nucleus pulposus can be shrunk to relieve the symptoms.