Ignorance has never left: 1 case of lumbar disc herniation improper conservative treatment
On November 7, 2022, a patient came to me for treatment through an acquaintance in our hospital. The acquaintance said that this patient had seen other doctors in our hospital and all recommended surgery. Then an acquaintance in our hospital suggested that the patient came to me for a look and analyze the condition to see whether it was better to treat conservatively or to operate.
patient is a male, 40 years old. The main pain is stiffness in the waist for more than 2 months, numbness in the lower limbs of the left for 33 days, severe at night, severe pain in the waist and left lower limbs when sleeping, severe in the morning, relieved after activity, and around dinner in the afternoon, the symptoms are the mildest, intermittent claudication in 500-600 meters, coughing in and sneezing, and the symptoms of the waist worsen, and dare not move. The sitting position is more comfortable than lying, but you cannot sit for a long time, and you are not flexible in going up and down the stairs. Intermittent attacks, like ordinary people when there is no attack, and it is difficult to walk during attacks. Urination and defecation are normal. I dare not use force when sitting on the toilet when defecating. It is difficult to get on and get off the car. The lumbar spine MRI in the outer hospital in September 2022 showed that the lumbar disc 4-5 was herniated and broke into the spinal canal. In mid-September 2022, I was hospitalized in 518 hospitals for conservative treatment, infusion of mannitol , etc., and I also performed treatments such as traditional Chinese medicine, lumbar sacral acupuncture, massage, and plaster external application in other places, and the effects were not obvious. I have a history of drinking, with more than 10 bottles of beer and 1 pack of smoking per day.
Figure 1. 20220922 Weike Hospital Magnetic Resonance 01, sagittal scan, showing the lumbar 4-5 disc herniation and entering the spinal canal.
Figure 2. 20220922 Health Test Hospital Magnetic Resonance 02, cross-sectional scan, it seems that the intervertebral disc herniation is not serious. It does not cause much space occupancy or severe compression of the nerve roots.
Figure 3. 20220922 Weike Hospital Magnetic Resonance Report
Figure 4. 20220923 Weike Hospital Magnetic Resonance 01, T2 phase, sagittal plane scan prompts lumbar 4-5 disc herniation and entering the spinal canal.
Figure 5. 20220923 Weike Hospital Magnetic Resonance 02, sagittal surface T1 phase scan shows that the lumbar 4-5 disc herniation and enters the spinal canal.
Check: Following, plantar walking, and jumping without restrictions, squatting without restrictions, but the waist is stiff and the bend is slightly limited. The large flakes of the lumbar sacral area are ulcerated, which is caused by traditional Chinese medicine, acupuncture, massage, and external plaster. The muscle strength of both lower limbs is normal, and the lateral side of the left calf is reduced.
Diagnosis: (Luburnal 4/5) Lumbar disc herniation; Osteoporosis
Figure 6. 20221107 My outpatient medical record 1
Because the patient has severe symptoms at night, the pain in the waist and left lower limbs during sleep, severe in the morning, and relieve after activity, etc. Consider that he should also suffer from Osteoporosis , give a bone density test, and check the lumbar magnetic resonance. Bone density prompts normal.
The lumbar spine MRI reviewed on November 7, 2022 showed that the lumbar disc herniation was smaller or no enlargement compared with the lumbar MRI on September 22. It is recommended to continue conservative treatment.
Figure 7. 20221107 Xijing Hospital MRI01, T2 phase sagittal scanning showed that the lumbar 4-5 disc herniation. Compared with the magnetic resonance of the outer hospital on September 22 and 23, 2022, the herniated intervertebral disc seemed to have become smaller or no enlargement.
Figure 8. 20221107 Xijing Hospital MRI02, sagittal surface T1 phase scan, indicating that the lumbar 4-5 disc herniation, enters the spinal canal, and the posterior edge of the lumbar 5 vertebrae. It appears that the herniated discs shown in MRI in the outer hospital on September 22 and 23, 2022 have become smaller or no enlargement.
Figure 9. 20221107 Xijing Hospital MRI03 shows lumbar disc herniation, but it does not seriously occupy the spinal canal volume or compress the left nerve root canal.
Figure 10. 20221107 The appearance of the lumbosacral skin of the patient has undergone various strange treatment measures, resulting in skin ulceration.
For this kind of skin lesions, even if the patient's lumbar disc herniation requires surgery, it cannot be done because this skin condition is a contraindication for surgery. If this patient really causes nerve damage due to tossing and emergency surgery is required, this skin condition will lead to an extremely increased risk of infection.
For elective surgery, this skin condition is a contraindication for surgery. Therefore, I advise the patient to continue conservative treatment. When the patient comes to the hospital, he will use his waist circumference to brake. I told the patient not to use his waist circumference to cure his skin ulcer first and then use his waist circumference. Keeping the lumbosacral skin dry and clean can help heal the skin ulceration.
Diagnostic and treatment suggestions:
Maizhiling tablets (Nanjing Xingyin), 2*150mg*20, 1.00*150mg, 2/day, oral
Figure 11. 20221107 My outpatient medical record 2
When I saw the skin condition of the lumbar sacral part of this patient, it reminded me of a case I encountered in 1998, thoracic spinal canal stenosis, small needle knife treatment, and finally the condition developed to paralysis. The case transferred to our hospital for treatment. The entire back was covered with small needle knife marks, suture marks and infections.
Figure 12. In 1998, the small needle knife for treating paralysis with thoracic spinal canal stenosis in small needle knife for treatment of paralysis with thoracic spinal canal stenosis in small needle knife for treatment of paralysis with thoracic spinal canal stenosis in 1998, the small needle knife for treating paralysis with thoracic spinal canal stenosis in 2
This case prompted me to establish the most standardized orthopedic case discussion website in China, China Orthopedic Network, which is committed to case discussion for orthopedic doctors and promote correct orthopedic professional medical knowledge, hoping to avoid such things as much as possible.
March 16, 2021, I wrote an article to push cervical spondylosis . After improper massage of cervical cone canal stenosis, the case of incomplete paralysis of limbs, and urinary incontinence:
My outpatient medical record: A painful lesson, cervical spondylosis caused incomplete paralysis after massage, urinary incontinence
On March 10, 2022, I pushed another case in the swordsman Curie:
The back was stabbed into a sieve by a small needle knife, so I came to see me for treatment. Ankylosing spondylitis, osteoporosis, lumbar 1 compression fracture, can a small needle knife be treated?
https://mp.weixin.qq.com/s/XHLLBXmvonpFzI0arWPuPA
shows many cases of improper treatment resulting in back skin damage.
By November 2022, it is almost 2023. This kind of ignorant way to treat lumbar disc herniation, causing large-scale skin and soft tissue damage to is still popular. This waist 4-5 ulcerated disc herniation patient, a male, 40 years old, jun, senior intellectual, and an acquaintance and comrade-in-arms with a director of our hospital, that is, people with medical resources. It was so blind that I was a little surprised and unexpected.
Popularization of medical professional knowledge requires more effort and a long way to go.
