Author丨 Department of Pain, Peking University Third Hospital Huang Xin
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lumbar disc herniation , how does it happen?
Lumbar disc is a soft pad between the two lumbar vertebrae. It is composed of the outer annulus and the inner nucleus pulposus , which can play a role in connecting and buffering. When repeated stress is applied, it will gradually degenerate, causing damage to the fibrous annulus and protrude from the weak annulus, which will in turn cause compression of the nerves in the spinal canal (Figure 1). Lumbar disc herniation (referred to as lumbar protrusion) is the most common cause of lumbar leg pain.
Figure 1. Lumbar disc herniation, compressing the nerves that dominate the legs behind the disc
Can lumbar syndrome be treated conservatively?
Lumar disc herniation can be conservatively treated. In clinical practice, 80-90% of patients with lumbar disc herniation can be cured through non-surgical treatment. Because most patients with lumbar disc herniation are mild and their nerve compression is not severe, the correct conservative treatment method can achieve good results.
Conservative treatment methods include: short-term bed rest, medication (anti-inflammatory and analgesic, nutritional nerves), traction, physiotherapy, acupuncture, correcting lifestyle, rehabilitation exercise, etc. Conservative treatment can reduce the stimulation of the herniated disc to the nerve roots, reduce edema and inflammation of the nerve roots, thereby alleviating the symptoms of lower back and leg pain.
What effect can conservative treatment achieve?
The purpose of conservative treatment is to relieve symptoms, relieve pain, and help everyone return to normal work and life. However, for most patients, conservative treatment does not necessarily return to a completely asymptomatic state. Only relieve symptoms, to a tolerable, acceptable, or even negligible level. For most mild eccentric and protrusion, conservative treatment often achieves better results due to the mild nerve compression and the degree of nerve radiculitis and damage.
Why is my back pain bad?
For moderate to severe anomalies, it will cause persistent nerve compression to the nerves, causing neuroinflammation, edema and even necrosis, thereby causing chronic neuropathic pain. At this time, conservative treatment often fails to achieve ideal results. This situation is very troublesome!
Although the waist aches are destined to death, it hurts as soon as you walk, and it hurts when you sit. Sometimes you will wake up even when you sleep, which is extremely painful (Figure 2)! Many patients cannot go to school or work, and cannot have normal social life at all. This impact is not a day or two, but years and years. If this chronic pain continues, it will greatly affect the patient's mood. In severe cases, it may even cause depression, which is manifested as a depression, loss of confidence in life, and worry about the future. Some patients even call it "immortal cancer."
Figure 2. Lumbar disc herniation can easily cause chronic low back and leg pain
According to a study on the burden of disease in China published in the international authoritative medical journal "The Lancet" in 2013, lower back pain, neck and shoulder pain and osteoarthritis have become the main causes of the top ten disabling diseases in the Chinese population, among which lower back pain ranks first in China's disabling diseases (Figure 3)!
Figure 3. Lower back pain ranks first among the top ten disabling diseases in China
Conservative treatment can naturally absorb the prominent interdisc of
?
This is a very concerning issue for many people and it is also everyone's wish.
The "Guidelines for the Diagnosis and Treatment of Lumbar Disc Herniation" released by the North American Spine Surgery Association, an international authoritative organization, mentioned: There is currently no relevant research on the natural course of lumbar disc herniation.However, the expert group agreed that most patients with lumbar disc herniation can improve regardless of treatment or not.
Herniated disc tissue usually atrophy/degeneration over time. Most studies (but not all) show that clinical symptoms gradually recover as the herniated disc decreases. The New England Journal of Medicine also published cases of natural absorption after non-surgical treatment of lumbar disc herniation.
We have also encountered such cases in clinical work. A month ago, I decided to operate due to severe pain in the lumbar disc herniation. After admission, I checked and found that the herniated disc was gone and there was no need for surgery. I was discharged immediately. The patient is so happy that he applauds himself, which is very lucky! But in fact, only a very small number of disks will absorb them by themselves. There are many patients with lumbar dysfunction in the hospital, and only a few cases can be absorbed by themselves every year.
According to clinical experience, the proportion of the total natural absorption of the prominent disc is about 1%. What can be absorbed by itself is basically the complete ejaculation of the nucleus pulposus in the lumbar disc. The process of natural absorption is also very fast, and it can be completed within about one month. If there is no absorption for several months, the possibility of absorption is usually not high. Some patients also have very serious protrusions. Although the protrusion disc is naturally absorbed, the compression period before was too long, which left the sequelae of nerve damage.
When should surgical treatment be considered?
The indications for surgery are as follows:
1. After being sick for more than half a year, regular conservative treatment is ineffective, which seriously affects work and life.
2. Conservative treatment is effective, but symptoms recur and painful.
3. Muscle strength declines, muscle atrophy, and even foot sagging and urination are uncontrollable.
Lumbar disc herniation, although the cause is degeneration and herniation of the lumbar disc, its victims are mainly compressed lumbar nerve roots. Whether the treatment can be conservatively treated and whether surgery is required, we have to ask the victims how they feel! When the nerve roots are compressed, they will feel pain, inflammation, edema, and even lose their function! If muscle strength decreases and muscle atrophy occurs, it means that the nerves are gradually becoming deteriorated.
Conservative treatment can stop nerve damage? Can it restore nerve function? It's very difficult! At this time, we are racing against nerve damage! If surgery is performed as soon as possible to relieve the compression of the nerve roots, there is still a possibility of recovery. If the pressure is over for a long time, the nerves will be irreversible. After the operation, the strength of the lower limbs will not be restored.
For foot sagging and abnormal urination, it is clinically called " tail equine syndrome ". If the surgery is not performed as soon as possible, it is likely to lead to serious and irrecoverable nerve damage! There is no way to urinate or defecate, and this is more serious than not being able to walk! In ancient times, there was no surgery to choose from, and such a situation might lead to lifelong disability. Fortunately, modern medical technology is developing rapidly, and there are currently very mature minimally invasive treatment plans.
foot sagging
How about minimally invasive surgery for lumbar spine?
Currently, minimally invasive spinal surgery represented by intervertebral foramen (Figure 4) is very mature. The surgery has a small incision, low trauma, fast recovery, and can be completed under local anesthesia, and can achieve ideal therapeutic effects. At present, China and international lumbar disc herniation diagnosis and treatment guidelines are jointly recommended. For poor lumbar pain, if the effect is still poor after systematic conservative treatment and continues to affect daily life, it is better to remove it through very minimally invasive means.
This method not only does not cause additional damage, but is more conducive to the recovery of neurological functions. It can allow patients to restore normal work and life in the early stage and get out of the haze of chronic pain. Most patients who have minimally invasive surgery have high satisfaction. Many patients think that it is so simple to know it before, just do it early, and don’t have to endure chronic pain for so long.
Figure 4 Minimally invasive treatment of lumbar disc herniation
I believe that after reading this article, you have made your own judgment on whether to choose a conservative treatment for lumbar pain. Because the disease itself is usually very complicated, if you are not sure about it, it is recommended that you consult a doctor in the hospital and seek professional guidance and help.
Expert introduction
Huang Xin
Huang Xin, chief physician of the Department of Pain, Peking University Third Hospital, and Ph.D. in orthopedics, Peking University. He has been studying and working in the trauma orthopedics department of Beijing Jishuitan Hospital, , , schia surgery department of Beijing Medical University, and supra medicine department of Beijing Medical University for ten years.
The main research direction is digital positioning technology for minimally invasive spinal surgery. As a core member of the project, participating in the "13th Five-Year Plan" National Key R&D Plan, National Natural Science Foundation and other projects, he published five SCI papers in international academic journals. He won the China Good Doctor of the Year in 2019, 2020 and 2021.
Academic position:
Youth member of the minimally invasive surgery group of the Orthopedic Branch of the Chinese Medical Association;
A member of the Lower Back Pain Science Group of the Chinese Medical Association.
professionally specializes in:
minimally invasive treatment of lumbar disc herniation, lumbar spinal stenosis, lumbar spondylosis , discord-derived low back pain, cervical spondylosis and other spinal diseases.
outpatient information:
Every Tuesday morning and Friday afternoon, the Pain Medicine Center of Peking University Third Hospital is on the hospital.
Every Tuesday afternoon, the Northern Campus Pain Medical Center of the Third Hospital of Peking University will be on the clinic.
Every Wednesday morning, the Pain Medical Center of the Airport Campus of Peking University Third Hospital is on medical treatment.
Every Wednesday afternoon, the Pain Medical Center of the Party School of Peking University Third Hospital will be on the clinic.
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