Mama Li, who lives in Tangshan Luannan County, is 55 years old. Recently, she found that her waist would feel uncomfortable after walking for a long time. If she continued to walk, her calves would become numb, so she went to the county hospital to see an orthopedic surgeon. The doctor asked her to undergo surgery. A lumbar X-ray showed that she might have a herniated intervertebral disc; she was referred to the city hospital for an MRI, and the results showed that her lumbar intervertebral disc did indeed have a herniated disc.
The doctor asked Mrs. Li if she wanted an operation? She was very worried. She heard that surgery was very dangerous. Without surgery, her foot might shrink in the future. How should she decide?
In fact, generally when people experience lower back pain connected to foot pain, the most common ones they think of are sciatica and intervertebral disc herniation, which will be explained separately below.
what is sciatic nerve pain?
The sciatic nerve is the largest nerve in the human body and runs quite long.
Lumbar disc herniation and sciatica disease surgery
- From the spinal canal out through the spinal gap, when passing through the spinal gap, you may be oppressed by the herniated intervertebral disc or too large bone spurs ;
- Next , when you walk to the pelvis, pass through the gap between the hip joint and buttock muscles, and reach the back of the thigh, you may be oppressed by the piriformis and gluteus maximus along the way;
- when you walk to the back of the thigh, you may be It is compressed by the biceps femoris and the thigh adductors;
- If you continue to go down to the outside of the calf, you may be compressed by the gap between the fibular head and the peroneal muscle.
When the sciatic nerve is compressed by these, the symptoms produced are quite similar. Patients will feel "numbness all the way to the feet", which can be broadly called sciatica.
X light shows bone spurs in the lumbar spine.
Bone spurs are places where bones proliferate due to long-term stress. Just like wrinkles will grow in places where the skin is frequently used, bone spurs will also grow in places where bones are often stressed. Almost everyone will have bone spurs. They are signs of chronic use, so don’t worry too much when the doctor says you have bone spurs. Bone spurs can tell us how we usually use our bodies.
Lumbar disc herniation, sciatica, disease, surgery
Generally speaking, if the bone spur does not cause inflammation or excessive proliferation that causes compression of the surrounding structures, there is usually no pain. If the bone spurs in the lumbar spine do not grow near the nerves, they will not compress the nerves.
MRI revealed a herniated intervertebral disc
The human spine is composed of 31 vertebrae , and the buffering soft tissue layer between the two vertebrae is called an intervertebral disc. When doctors mention "intervertebral disc herniation", we usually pay attention to three key points:
1. Which layer of intervertebral disc is the herniation?
Each layer of intervertebral disc herniation presses on different nerves, which will cause numbness in different locations. Do the herniated discs on the images match the clinical locations of numbness and pain?
2. Will the protruding position compress the nerves?
Lumbar disc herniation Sciatica Disease Surgery
In terms of cross section, intervertebral disc herniation is divided into central type, left type, right type, and far lateral type. Only the left type and right type will compress the nerve root.
3. Is the outstanding situation serious?
The severity of intervertebral disc herniation is clinically divided into 4 levels:
- Level 1 disc herniation usually does not compress nerves,
- Levels 2 and 3 are more likely to compress nerves,
- Level 4 disc herniation just It hurts so much when it happens.
However, because the intervertebral disc has dissociated and fallen out, it is completely absorbed relatively quickly. As long as painkillers can be used to survive the acute phase, surgery is not necessarily required.
Intervertebral disc herniation may be caused by two reasons:
- 1. Caused by external force: It is usually caused by sudden severe pain caused by falling injury or lifting heavy objects. The intervertebral disc may rupture and fall out.
- 2. Caused by degeneration: The annular ligament that protects the intervertebral disc gradually ages and softens, causing the intervertebral disc to bulge outward.
Medical research shows that if a 65-year-old man with no lower back pain undergoes a waist health examination, 1/3 will have a herniated disc. It can be seen that a herniated disc does not necessarily cause back pain, nor does it necessarily compress the sciatic nerve.
Lumbar disc herniation, sciatica, disease, surgery
If you or a relative or friend learns that you have a herniated disc, don’t panic. You can first analyze whether it is just a degenerative mild herniation.
Intervertebral disc herniation and sciatica, do you need surgery?
First of all, we need to determine whether the symptoms are caused by intervertebral disc herniation. Patients can do a simple self-test:
If you feel severe electric pain when getting in and out of bed, bending forward and backward at the waist, and it spreads all the way to one side of your calf, it may be an intervertebral disc. Sciatica caused by sciatica; conversely, if waist movement does not cause electric pain, but is very sore and hard near the buttocks and requires frequent beating, it may be sciatic nerve compression caused by the contraction of gluteal muscles , but there is no need to consider the lumbar spine first. Operation.
Lumbar disc herniation and sciatica disease surgery
If it is determined that the sciatica is caused by the lumbar spine, according to medical principles, conservative treatment should be carried out first, that is, drug treatment, rehabilitation treatment, exercise treatment, and local injection treatment to slow down the symptoms. Slow remission; if left unchecked and the symptoms worsen to incontinence, neurological atrophy of lower limb muscles, or pain that cannot be controlled by drugs, surgical intervention should be considered.
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