Liu, Professor of Orthopaedics, Peking University Third Hospital.
Family Medicine, May 2003
In modern society, great changes have taken place in people's lifestyles. People spend more and more time in meetings, using computers, driving cars and taking buses. With the acceleration of work rhythm, people have less and less time to exercise. This "more" and "less" has led many people to suffer from lumbar disc herniation (referred to as "lumbar process") prematurely. What are the manifestations of lumbar process? Is the treatment really what some advertisements say? How to prevent it in peacetime? This magazine specially invites experts to write articles to guide readers.
One day, I received a 40-year-old male patient in the orthopedic clinic, who looked like an intellectual. With a full face of pain, he stooped into the consulting room. When I gave him a physical examination, he was busy describing:
"My right leg hurts for more than half a year. From the right hip to the thigh and calf, the calf and instep are numb. After a few days' rest, the pain will be relieved, so it won't matter. I squatted in the yard yesterday to trim the flowers and plants. When I suddenly stood up, my right leg suddenly got a sharp pain. After sleeping for a day and not getting better, I quickly went to the hospital. "
After examination, it was found that the muscles of the patient's right thigh and calf were slightly atrophied, the pain sensitivity of the skin on the outside of the calf and the back of the foot was weakened, and the strength of toe upturning was also obviously weakened. CT scan showed that the intervertebral disc between the 4th and 5th lumbar vertebrae of the patient had obviously protruded to the right and rear, which caused serious compression on the nerve roots. Obviously, the patient has a lumbar process.
"I have never been injured in the waist and rarely do heavy work. How can I get lumbar process? Since it is a lumbar disc herniation, why does the waist not hurt at all, but the leg hurts badly? " When I gave the patient a conclusion, the patient asked in confusion.
In fact, this is the "trick" that is often used to confuse and deceive patients with lumbar processes.
Low back pain and sciatica are warning signs of lumbar disc herniation. Low back pain is the earliest symptom of most patients with lumbar disc herniation, the incidence rate is about 9 1%, and sometimes low back pain can affect the buttocks. But at this time, many people have not paid enough attention to it because of the mild symptoms.
Sciatic neuralgia is a typical symptom of patients with lumbar disc herniation, and the incidence rate is about 97%. Sciatic neuralgia is often a radiation pain of "lower waist → posterior thigh → lateral calf → foot". Many patients and even some inexperienced doctors think that this kind of leg pain may be caused by something wrong with the leg, which has delayed the illness. In addition, when many patients sneeze or cough, they all have clinical manifestations of aggravated pain due to increased abdominal pressure.
In addition, a few patients have loose nucleus pulposus in the spinal canal, and cauda equina nerve in the spinal canal is responsible for perineal urination and defecation, and cauda equina nerve is compressed, which may lead to dysuria, perineal hypoesthesia or sexual dysfunction. Some patients will have lower limb muscle atrophy, ankle and toe motor dysfunction and so on. Because the nucleus pulposus has pressed the nerve root for too long.
Understand lumbar protrusion
Liu, Professor of Orthopaedics, Peking University Third Hospital.
Family Medicine, May 2003
Lumbar disc herniation accounts for a considerable part of patients with low back and leg pain. It is a syndrome caused by intervertebral disc degeneration, fiber breakage, nucleus pulposus protrusion, nerve root and cauda equina nerve being stimulated or compressed.
The human spine consists of 33 vertebrae: 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 sacral vertebrae and 4 coccygeal vertebrae. Cervical vertebrae, thoracic vertebrae and lumbar vertebrae are connected by intervertebral discs, while sacral vertebrae and coccygeal vertebrae have been integrated in the development process without intervertebral discs.
Intervertebral disc consists of tough fibrous ring around and gelatinous nucleus pulposus around the center. Under normal circumstances, the intervertebral disc not only connects and stabilizes the spine, but also supports the bending activity of the spine and buffers the pressure of the spine.
In principle, every intervertebral disc has the possibility of protrusion, but it is most likely to occur between the fourth and fifth lumbar vertebrae, and between the fifth lumbar vertebra and 1 sacrum, and the incidence rate accounts for about 90% ~ 96% of lumbar disc protrusion.
This is because the intervertebral disc between them, close to the lower end of the spine, usually bears a large range of gravity and activity, so the chances of injury and nucleus pulposus protrusion are the most.
Why do you get lumbar process? There are two main factors, one is the growth of age, and the other is trauma.
With the increase of age, the water content of the main components of the intervertebral disc, namely the annulus fibrosus and nucleus pulposus, gradually decreases, the tension of the nucleus pulposus decreases, the intervertebral disc becomes thinner, the nucleus pulposus gradually loses its elasticity, and even the structure of the intervertebral disc relaxes. At this time, under the action of some stress, the nucleus pulposus can jack up the fibrous ring, which is called "bulging" or "bulging".
If the intervertebral disc is damaged or even ruptured, the annulus fibrosus will become fragile. In light cases, the nucleus pulposus can be "prominent"; In the worst case, the nucleus pulposus can be squeezed out along the damaged part of the fibrous ring, which is called "hernia" or "prolapse". Whether it is "protrusion" or "prolapse", the intervertebral disc may compress the nerves walking in the spinal canal, causing the above clinical symptoms.
There is no doubt that the occurrence of lumbar process is related to waist activity and age. But its inducement is not limited to lumbar trauma or high-intensity lumbar load. Because most patients with lumbar disc herniation have no obvious history of trauma, many patients are even mental workers. In fact, chronic back strain and insufficient muscle strength around lumbar vertebrae are the main accomplices of lumbar processes. In modern society, lifestyle has changed a lot. People spend more and more time in meetings, using computers, driving and driving ... but the accelerated pace of work makes people spend less and less time on sports. This kind of "more" and "less" makes many people suffer from lumbar muscle strain and lumbar "aging" prematurely. This is the direct cause of the increased prevalence of lumbar disc herniation and the "rejuvenation" of the disease.
● About the author:
Liu is the director, chief physician, professor and doctoral supervisor of the Institute of Spinal Surgery of Peking University Third Hospital. Focus on the clinical diagnosis and treatment of spinal trauma, deformity and tumor and the experiment of spinal cord injury. In recent ten years, he has published nearly 20 professional papers, participated in compiling or compiling 5 monographs on spinal surgery, translated monographs 1 department, and completed 4 topics related to spinal cord injury.
Be careful when choosing more treatments.
Zheng Rong Chen is a professor of orthopedics at Zhongshan Hospital affiliated to Fudan University.
Family Medicine, May 2003
For patients with lumbar disc herniation, there are two situations that are most likely to happen: one is not to see a doctor when the condition is mild, which leads to the aggravation of the condition; Second, go to the doctor at random when you are in a hurry. As a result, you spent money and delayed your illness. Therefore, patients must first get out of these two treatment misunderstandings in order to diagnose and treat their own condition in time and correctly.
Generally speaking, the treatment of lumbar disc herniation can be divided into conservative treatment (non-surgical treatment) and surgical treatment. Once the first-time patients are diagnosed clearly, conservative treatment should often be taken first.
conservative treatment
There are many conservative treatment methods, but the most important thing is to stay in bed absolutely during the onset, and you can walk on the ground with a belt after the symptoms are basically relieved. During bed rest, continuous pelvic traction should be carried out. If it can last for more than two weeks, the effect will be very good. The traction weight should be determined according to individual differences, and each side should be between 7 ~ 15 kg, with traction for 6 ~ 8 hours every day, during which you can take a proper rest for 2 ~ 4 times to relax. In some hospitals, rapid traction lasts for tens of minutes at a time, but the effect is not stable.
Some patients don't want surgery, and doctors will treat them with intravenous mannitol or hormones. The main function is to eliminate inflammation and edema. This method can temporarily relieve the patient's pain, but in the long run, it is unreliable.
When some patients are treated for acute attack, doctors suggest closing the medullary canal, that is, injecting a mixed solution containing anesthetic and hormone into the part of the patient's spinal canal that protrudes and compresses the nerve. Sometimes it does have an immediate effect, but there are also cases where it takes a long time to inject again. Because there are fine powder particles in the injected hormone drugs, it is not easy to be absorbed. Repeated injection will make these particles follow around the nerve root, leading to adhesion between the nerve root and the surrounding tissues, and the adhesion itself will also stimulate the nerve root. Some patients are still ineffective after repeated injections, and finally they have to undergo surgery. At this time, adhesion increases the difficulty of surgery. If the surgeon is inexperienced, it will often damage the nerves and may also cause surgical complications.
Some advocate the method of injecting chemoenzymes into intervertebral disc, because this method is incomplete and risky, and few doctors are willing to use it. When this drug is injected, if it leaks from the intervertebral disc and enters the spinal canal, it will have serious consequences, which can damage normal nerves and cause incontinence and paralysis of both lower limbs. Therefore, it must be used with care and the surgeon's skill must be very skilled before it can be considered.
Some patients can also try to do some massage and manual massage, which can also relieve symptoms and have cases of cure. But be sure to ask a professional massage doctor for treatment. The specific massage needs several courses of treatment, and the massage doctor will deal with it according to the different conditions of the patient.
surgical treatment
As for surgical treatment, there are two kinds: minimally invasive surgical treatment and ordinary spinal canal decompression and nucleus pulposus removal. Minimally invasive surgery is an endoscopic discectomy. This kind of operation has been used in China for more than ten years, and the technology and instruments are constantly improving and perfecting. However, this minimally invasive surgery may have the shortcomings of incomplete treatment and narrow surgical indications, and it is necessary to improve the strict control of surgical indications.
Another method is general decompression of spinal canal. This kind of operation is not a problem in municipal and district hospitals, and it can relieve the pain of patients smoothly. Some patients have lumbar instability besides disc herniation, that is, lumbar degeneration caused by long-term compression. At this time, in addition to nucleus pulposus removal and decompression, pedicle screw internal fixation and fusion of multiple lumbar segments are needed. This kind of operation is traumatic, and unskilled people will cause some complications. But if the technical level and medical conditions of the hospital are standardized, it can still be considered.
● About the author:
Chen Fudan University Affiliated Zhongshan Hospital Orthopedic Director, Chief Physician, Professor and Doctoral Supervisor. He has been engaged in orthopedic clinical work for nearly 30 years and has rich experience in the diagnosis and treatment of lumbar diseases, bone tumors and joint diseases. He has published and participated in the compilation of more than one monograph 10, published nearly 100 papers, and applied for fund support 10.
Four main points of preventing lumbar disc herniation
Professor of Orthopaedics, Xiangya Hospital, Li Central South University
Family Medicine, May 2003
Lumbar process is a common disease among young adults, which seriously affects people's labor force and quality of life. However, as long as we pay attention to prevention and health care, the lumbar process will stay away from you.
1. Strengthen exercise and keep fit.
The basic causes of lumbar disc herniation are lumbar disc degeneration, lumbar trauma and overwork. So through exercise, the bones and back muscles will be strong and the nervous system will react quickly. Therefore, in various activities, the movements will be accurate and coordinated, and the lumbar spine is not easy to be injured. At the same time, exercise is beneficial to reduce the lumbar load, delay the degeneration of lumbar intervertebral disc, and thus prevent the occurrence of lumbar disc herniation.
The ways of exercise can vary from person to person and suit local conditions, such as doing radio exercises, aerobics, playing Tai Ji Chuan and other sports activities.
2. Keep the correct working posture.
Correct posture can not only improve labor efficiency, but also prevent lumbar muscle strain and delay intervertebral disc degeneration, thus effectively preventing lumbar disc herniation.
Here are some common postures that help protect the lumbar spine:
Standing worker: Hips and knees are slightly flexed, preferably around 15 degrees. The abdomen naturally contracts, and bilateral hip muscles contract inward, so that the pelvis leans forward and the lumbar spine straightens.
Seating workers: Adjust the height of the chair so that the knees can bend and stretch freely, and the upper lumbar spine is close to the armchair to keep the spine straight. The chair seat plate should not be too narrow, and it should be able to support two thighs.
Laborers (such as cooks, hairdressers, etc.). Those who need to bend over half due to the nature of their work: keep their lower back straight, keep their feet apart and parallel to their shoulders, and let gravity fall on their hips and feet. When bending down to carry heavy objects, you should stretch your waist first, then bend your hips and squat down, then straighten your hips and knees hard, and straighten your waist to lift heavy objects; When lifting heavy objects collectively, you should hold out your chest, bend your hips first, and then lift heavy objects at the same time.
3. Do a good job in labor protection and improve working conditions.
Workers who often bend over or pick heavy objects can use wide belts to strengthen the stability of the waist. However, the wide belt can only be used at work, and it should be taken off at ordinary times, otherwise it will lead to the weakening of waist strength and even muscle atrophy, leading to low back pain.
No matter what job or occupation, working hours should not be too long in a certain fixed posture. Especially when you bend over or twist your body repeatedly, you should change your posture regularly to rest your tired muscles.
The driver of the car sat in the chair for a long time and suffered from bumps and vibrations. Over time, the pressure on the lumbar intervertebral disc increases, which easily leads to disc degeneration and disc herniation. Therefore, the driver should have a reasonably designed seat, pay attention to the correctness of the seat, and avoid or reduce vibration. Let the waist move and rest properly during driving.
The invasion of wind, cold and humidity can reduce the immune function of the body, shrink small blood vessels, muscle spasm and cause low back and leg pain. The continuous spasm of the muscles in the lower back will lead to the increase of intervertebral disc pressure and induce lumbar protrusion. Therefore, whether in productive labor or daily life, we should avoid the intrusion of wind, cold and dampness.
During pregnancy and lactation, due to endocrine changes, the muscles, joint capsules and ligaments of the lower waist and pelvis relax, the load of the lower lumbar spine increases, and the internal pressure of the intervertebral disc increases, which is prone to lumbar disc herniation. Therefore, heavy physical labor should be avoided during pregnancy and lactation.
4. quit smoking.
Smoking too much can also cause low back pain, because some chemicals in tobacco leaves can make blood vessels contract, the blood vessel wall is ischemic and anoxic, and the nutritional status of intervertebral disc deteriorates, thus accelerating intervertebral disc degeneration. At the same time, smoking can cause cough, and severe cough will increase the pressure in the intervertebral disc, promote the degeneration of the intervertebral disc and lead to lumbar disc herniation, so quit smoking.
● About the author:
Li, chief physician, professor and doctoral supervisor, is currently the deputy director of surgery in Xiangya Hospital of Central South University, director of orthopedic research office, director of Hunan Medical Association and chairman of Hunan Spinal Surgery Professional Committee. He has been engaged in orthopedic clinical work for nearly 30 years, published more than 60 papers, won 6 scientific research achievements at all levels, national patents 1 item, and 6 major and participating works.
Lumbar process-solving puzzles
Family Medicine, May 2003
Q: Which people are prone to lumbar protrusion?
Liu Jiaoshou: Generally speaking, lumbar disc herniation can occur in almost everyone, but according to the statistics and analysis results of clinical cases, the incidence of lumbar disc herniation is relatively high among young people aged 30-50. It is worth noting that in recent years, young patients in their twenties seem to have an increasing trend.
A further understanding of their professional characteristics and living habits shows that a high proportion of patients sit and work all day, such as car drivers, accountants and computer operators, or lack of back muscle exercise. This reflects from one side that bad living and working habits make the lumbar spine overloaded for a long time, which may be one of the main reasons for lumbar disc herniation.
Q: Will lumbar disc herniation recur after being cured?
Professor Chen: This question should be answered from two aspects: on the one hand, if the diagnosis is clear, the symptoms are typical simple lumbar disc herniation, and the operation of the surgeon is standard and standardized, then recurrence is rare.
In order to reduce recurrence, first of all, young patients (under 30 years old) should be treated conservatively as far as possible, and should not be operated easily, because the younger they are, the easier it is to relapse. Secondly, it is easy to cause lumbar instability after surgery, because the normal physiological structure of the lumbar spine has been destroyed, which will cause low back pain. If you don't pay attention to maintenance, such as working in a fixed position for too long, or bending over with heavy objects, or the stress on your waist is too concentrated, it will cause some adverse consequences. Even if it doesn't recur, it will lead to frequent discomfort in your waist and some symptoms similar to lumbar process.
On the other hand, in the case of unclear diagnosis, it is easy to cause recurrence or other symptoms if you go to surgery rashly or the operation of the surgeon is not standardized.
Q: The advertisement said that the most advanced, high-tech and large-scale full-computer stereo sow therapeutic instrument was used to treat disc herniation. The whole treatment process only takes 20 minutes. There is no surgery, no pain, no hospitalization and no sequelae. Is it true?/You don't say. Which method has the best treatment effect?
Liu Jiaoshou: Lumbar disc herniation has different treatment methods according to its type and degree. For those cases of disc herniation, especially the rupture of annulus fibrosus, nucleus pulposus prolapse and severe compression of nerve roots, surgery may be the only effective treatment. For most patients with less severe lumbar disc herniation, non-surgical treatment is usually effective.
At present, there is no cure-all method. In the absence of accurate diagnosis and classification of lumbar disc herniation, it is not only ineffective but also harmful to blindly adopt a certain treatment method. As for the "three-dimensional therapeutic instrument", the author has never used it, so it is inconvenient to make any evaluation.
Q: Is it credible that the ancestral secret recipe can completely cure lumbar disc herniation?
Liu Jiaoshou: I'm afraid this statement is unscientific. Oral administration of any panacea can not make the herniated intervertebral disc shrink by itself. If the so-called "ancestral secret recipe" contains anti-inflammatory and analgesic drugs, it may relieve the pain symptoms of patients, but it is unreasonable and unreliable to completely cure them.
Q: Some "magic doctors" claim that I touched your protruding intervertebral disc, and I can completely reset it with my medicine. Excuse me, is this credible?
Liu Jiaoshou: Lumbar intervertebral disc is a kind of connective tissue between lumbar vertebrae, and its anatomical position is deep. Lumbar intervertebral disc surgery needs to cut multiple layers of human structures and pass through the lamina, and then pull the nerve tissue to expose it. It is not difficult to imagine that it is impossible to contact the intervertebral disc from the body surface. As for the reset, let alone. These so-called "magic doctors" claim to be able to touch and reset, but they are actually just used to cheat money. Don't be trusted