Lumbar disc herniation can do surgery

Lumbar disc herniation is one of the more common diseases, mainly because of the lumbar disc parts (nucleus pulposus, annulus fibrosus and cartilage plate), especially the nucleus pulposus, there are varying degrees of degenerative changes, in the role of external factors, the disc's annulus fibrosus rupture, the nucleus pulposus tissue protrudes from the rupture place (or out) in the posterior or vertebral canal, leading to the adjacent spinal nerve roots suffered from irritation or compression, resulting in a series of clinical symptoms. Lumbar pain, numbness and pain in one or both lower limbs, and a series of clinical symptoms. Lumbar disc herniation has the highest incidence of lumbar 4-5 and lumbar 5-sacral 1, accounting for about 95%.

Treatment

1. Non-surgical treatment

Most patients with lumbar disc herniation can be relieved or cured by non-surgical treatment. The principle of treatment is not to return the degenerated and protruded disc tissue to its original position, but to change the relative position of the disc tissue and the compressed nerve root or part of the return, to reduce the compression on the nerve root, to loosen the adhesion of the nerve root, and to eliminate the inflammation of the nerve root, so as to alleviate the symptoms. Non-surgical treatment is mainly suitable for: ① young, the first attack or a shorter duration of the disease; ② mild symptoms, the symptoms can be relieved by themselves after rest; ③ no obvious spinal stenosis in the imaging examination.

(1) Absolute bed rest When the first attack occurs, bed rest should be strict, emphasizing that you should not get out of bed or sit up for both bowel movements and urination, so as to have a better effect. After 3 weeks of bed rest, you can wear a waistband to get up and move around under the protection of the waistband, and do not do bending over to hold things within 3 months. This method is simple and effective, but more difficult to adhere to. After relief, the low back muscles should be strengthened to reduce the chance of recurrence.

(2) Traction therapy The use of pelvic traction can increase the width of the intervertebral space, reduce the internal pressure of the intervertebral disc, the herniated part of the intervertebral disc back to reduce the irritation and pressure on the nerve root, and need to be carried out under the guidance of a professional doctor.

(3) Physiotherapy, massage and acupressure can relieve muscle spasm and reduce the pressure in the intervertebral disc, but note that violent massage and acupressure can lead to aggravation of the condition, and caution should be taken.

(4) Supportive therapy Supportive therapy with glucosamine sulfate and chondroitin sulfate can be tried. Glucosamine sulfate and chondroitin sulfate are clinically used in the treatment of osteoarthritis in all parts of the body, and these chondroprotectors have a certain degree of anti-inflammatory and anti-chondrolysis effects. Basic research has shown that glucosamine inhibits the production of inflammatory factors by spinal nucleus pulposus cells and promotes the synthesis of glycosaminoglycans, a component of the cartilage matrix of the intervertebral disc. Clinical studies have found that injection of glucosamine into the intervertebral disc can significantly reduce lower back pain caused by degenerative disc disease while improving spinal function. Some case reports suggest that oral administration of glucosamine sulfate and chondroitin sulfate can reverse degenerative disc changes to some extent.

(5) Corticosteroid epidural injection Corticosteroid is a long-acting anti-inflammatory agent that reduces inflammation and adhesions around the nerve roots. Generally, long-acting corticosteroid preparation + 2% lidocaine is used for epidural injection, once a week, 3 times for a course of treatment, and another course of treatment can be used after 2 to 4 weeks.

(6) Nucleus pulposus chemical dissolution method The use of collagenase or papain, injected into the intervertebral disc or between the dura mater and the protruding nucleus pulposus, selectively dissolve the nucleus pulposus and the annulus fibrosus without damaging the nerve root, in order to reduce the pressure in the intervertebral disc or to make the protruding nucleus pulposus become smaller so as to relieve the symptoms. However, this method carries the risk of producing an allergic reaction.

2. Percutaneous nucleus pulposus aspiration/nucleus pulposus laser vaporization

The procedure is performed by using a special instrument to enter the intervertebral space under X-ray surveillance, and part of the nucleus pulposus is crushed and sucked out or vaporized by the laser, thus reducing the pressure in the intervertebral disc and relieving the symptoms, and it is suitable for the patients who have bulging or mild herniation, and is not suitable for the patients with combined lateral saphenous stenosis or who already have obvious protrusion or those whose nucleus pulposus has already been dislodged into the vertebral canal.

3. Surgery

(1) Indications for surgery ① history of more than three months, strict conservative treatment is ineffective or conservative treatment is effective, but often recurring and severe pain; ② the first attack, but the pain is severe, especially in the lower limbs, the patient is difficult to move and sleep, in a forced position; ③ combined with the performance of the cauda equina nerve compression; ④ the emergence of a single root paralysis, accompanied by muscle atrophy, muscle strength decline; ④ the emergence of a single root paralysis, with muscle atrophy, muscle strength decline, muscle weakness, muscle weakness, muscle weakness, muscle weakness, muscle weakness, muscle weakness, muscle weakness, muscle weakness. Muscle atrophy and loss of muscle strength; ⑤ Combined with spinal stenosis.

(2) Surgical method: A posterior lumbar back incision is made, and part of the vertebral plate and synchondrosis are removed, or the disc is removed through the intervertebral plate space. Central type herniated disc, after laminectomy, transdural or intradural discectomy. Combined with lumbar instability, lumbar spinal stenosis, the need for simultaneous spinal fusion.

In recent years, minimally invasive surgical techniques such as microdiscectomy, microendoscopic discectomy, and percutaneous intervertebral foraminoscopic discectomy have minimized surgical injuries and achieved good results.