Lumbar Disc Herniation

　　Lumbar disc herniation is caused by a disorder of the balance between the inside and outside of the spine due to various factors, with the annulus fibrosus rupturing, and the nucleus pulposus and the posterior longitudinal ligament covering it protruding into the spinal canal, compressing the nearby spinal nerve roots and causing a series of clinical symptoms and signs. The following are some common causes of lumbar disc herniation:

　　1. Degenerative disc disease

　　Normal intervertebral discs are rich in elasticity and toughness and have strong compressive resistance. However, with the increase of age, the water content of the annulus fibrosus and nucleus pulposus gradually decreases. The tension of the nucleus pulposus decreases, the intervertebral disc becomes thinner, causing the loss of intervertebral disc height, thereby changing the mechanical structure of adjacent spinal segments, leading to spontaneous lower back pain, sciatica, intervertebral disc herniation, spinal canal stenosis, and spinal cord disease, and reducing the quality of life and labor capacity of patients. Magnetic resonance imaging has confirmed that intervertebral disc degeneration can occur in adolescents as young as 15 years old. Diseases caused by degeneration are a major challenge for clinical physicians.

　　2. Congenital abnormalities

　　Factors such as developmental abnormalities of the lumbosacral region and asymmetry of the articular processes.

　　3. Inflammatory reactions

　　There is now sufficient evidence to confirm that there are inflammatory cells in the herniated intervertebral disc tissue, and inflammatory reactions play an important role in the process of intervertebral disc herniation. Researchers took out the nucleus pulposus tissue from dogs, crushed it evenly, and then injected these fragments into the vicinity of the dog's nerve roots. Compared with the group injected with physiological saline, severe inflammatory reactions can be observed under a microscope. This result shows that the autologous nucleus pulposus tissue can cause chemical inflammatory reactions in the nerve roots, which can cause significant pain.

　　4. Injury

　　The stability of the lumbar spine relies on the structure of the spine itself and the related muscle system. The lack of movement and the nutritional disorder of the neuromuscular system caused by compression of the nerve roots can lead to muscle weakness and imbalance, a decrease in lumbar stability, and make lumbar disc herniation difficult to heal or recurrent. Long-term cumulative trauma and strain on the lumbar spine are the main causes of intervertebral disc degeneration and are also triggers for intervertebral disc herniation. Repeated bending and twisting movements are most likely to cause intervertebral disc injury. Therefore, this condition is closely related to certain professions and trades. Such as white-collar workers, drivers, and bending laborers who work in a seated position for a long time.

　　5. Exposure to cold

　　Many patients with lumbar disc herniation have no history of trauma or strain, but only a history of exposure to cold and coolness. The reason may be that after the waist is exposed to cold, the lumbar and back muscles spasm and the small blood vessels contract, affecting local blood circulation and thereby affecting the nutrition of the intervertebral disc. At the same time, the tension and spasm of the muscles can increase the pressure on the intervertebral disc, especially for intervertebral discs that have already degenerated, which can cause further damage. This leads to nucleus pulposus prolapse.

　　Lumbar disc herniation is one of the main causes of lumbar and leg pain and is a common disease in orthopedic clinical practice. The following are common complications of lumbar disc herniation:

　　1. Formation of lumbar osteophytes

　　There are often osteophytes at the adjacent edges of degenerated intervertebral discs. Large osteophytes in the intervertebral foramen and on the posterior longitudinal ligament can compress the nerve roots and lead to complications of lumbar disc herniation.

　　2. Degenerative lumbar spondylolisthesis

　　Instability of the lumbar spine and spondylolysis of the articular process are caused by intervertebral disc herniation and degeneration, both of which are the main causes of degenerative lumbar spondylolisthesis. They will cause various lumbar and leg symptoms and are also one of the common complications of lumbar disc herniation.

　　3. Thickening and calcification of the yellow ligament

　　This is a relatively common complication of lumbar disc herniation. The thickening of the yellow ligament >1cm is caused by chronic lumbar muscle strain. The thickening of the yellow ligament between the vertebral plates can cause stenosis of the spinal canal and compress the dura mater sac, while the thickening of the yellow ligament in the joint capsule can compress the nerve roots, producing symptoms similar to those of intervertebral disc herniation.

　　4. Degeneration and bone hyperplasia of the posterior joint

　　For lumbar disc herniation complications with a long history of lumbar and leg pain, there are degeneration of the posterior joint and bone hyperplasia. On the one hand, it is manifested by the narrowing of the intervertebral space and relaxation of the intervertebral disc due to the herniation and degeneration of the lumbar intervertebral disc, and on the other hand, the bone hyperplasia of the superior articular process can further narrow the intervertebral foramen, increasing the chance of nerve root compression.

　　5. Narrowing of the intervertebral disc

　　The localized narrowing of intervertebral disc height in adults is caused by the reduction of nucleus pulposus water content. During lumbar disc herniation, it may accelerate its progression. The narrowing of the intervertebral space can cause subluxation of the posterior joint, excessive displacement of the articular process, causing stenosis of the lateral recess and intervertebral foramen, leading to complications of lumbar disc herniation.

　　Lumbar disc herniation is a common clinical disease with a wide range of patients, causing great pain to patients. Clinically, it often accompanies the following symptoms:

　　1. Low back pain

　　Clinically, persistent dull pain in the lower back is more common, which is relieved when lying flat and exacerbated when standing. In general, it can be tolerated and allows moderate lumbar movement and slow walking. Another type of pain is severe spasmodic pain in the waist, which is sudden and acute in onset, often difficult to bear, and presents a series of changes such as ischemia, congestion, hypoxia, and edema.

　　2. Radiating pain in the lower limb

　　Mild cases may present with radiating sharp pain or numbness from the waist to the thigh and the posterior aspect of the calf, reaching the sole; it is generally bearable. Severe cases may present with an electric shock-like severe pain from the waist to the foot, often accompanied by numbness. Although those with mild pain can still walk, their gait is unsteady and shows limping.

　　3. Numbness in the limbs

　　It often occurs with the former, and those with simple numbness without pain only account for about 5%.

　　4. Cold sensation in the limbs

　　A few cases (about 5% to 10%) feel coldness and coolness in their limbs.

　　5. Intermittent claudication

　　It may appear as the pathological and physiological basis of secondary lumbar spinal canal stenosis; for those with congenital developmental narrowing of the spinal canal sagittal diameter, the extruded nucleus pulposus further aggravates the degree of spinal canal stenosis, making it more prone to induce this symptom.

　　6. Muscle paralysis

　　Mild cases may show muscle weakness, while severe cases may result in the loss of muscle function.

　　7. Cauda equina syndrome

　　The main manifestations include numbness and tingling in the perineum, defecation and urination disorders, impotence (in males), and symptoms of sciatic nerve involvement in both lower limbs. In severe cases, incontinence of urine and feces and incomplete paralysis of both lower limbs may occur.

　　8. Pain in the lower abdomen or anterior thigh

　　In high lumbar disc herniation, when the L2, L3, and L4 nerve roots are involved, pain in the lower abdominal inguinal area or the anterior and medial aspect of the thigh, which is innervated by the nerve roots, appears. This kind of pain is mostly referred pain.

　　9. Lower skin temperature of the affected limb

　　Similar to the cold sensation of the limbs, the compression of the S1 nerve root is more obvious than that of the L5 nerve root.

　　Lumbar disc herniation often occurs in males aged 20-50, with various causes, mostly related to long-term labor and prolonged sitting. This disease can bring great pain to patients and should be paid great attention. In our daily lives, we should develop good working and eating habits, exercise, and have regular physical examinations. Specifically, we can prevent the occurrence of the disease from the following aspects:

　　1. Strengthen exercise

　　By exercising to strengthen the body, the bones and lumbar muscles will become strong and powerful, and the nervous system response will be agile. Therefore, in various activities, movements will be accurate and coordinated, and the lumbar spine is less likely to be injured. At the same time, exercise is beneficial to reduce the load on the lumbar spine and delay the degenerative changes of the intervertebral disc, thereby preventing the occurrence of lumbar spondylosis. The way of exercise can vary from person to person and place to place, such as doing physical exercises, aerobics, Tai Chi, and other sports activities.

　　2. Maintain correct working posture

　　The following are some common postures that are helpful for protecting the lumbar spine: for standing workers: the hip and knee joints are slightly flexed, about 15 degrees is appropriate, naturally draw in the abdomen, both sides of the buttock muscles are contracted inward, so that the pelvis is anteriorly inclined, and the lumbar spine becomes straight. For sitting workers: adjust the height of the chair so that the knees can flex and extend freely, the upper lumbar spine is close to the backrest chair, and maintain the spine straight. The seat of the chair should not be too narrow, it should be able to support both thighs. For workers who need to bend over for half of their work: keep the lower back straight, the feet should be spread apart and parallel to the shoulders, so that the weight is on the hip and feet. When bending over to lift heavy objects, first extend the waist, then flex the hips and squat down, then extend the hips and knees, straighten the waist to lift the heavy object; when lifting heavy objects collectively, stand up straight, first flex the hips and squat down, then lift the heavy object together.

　　3. Quit smoking

　　Excessive smoking can also cause back and waist pain. At the same time, smoking can cause coughing, and severe coughing can increase the intradiscal pressure, promote the degeneration of the intervertebral disc, leading to lumbar disc herniation, so it is advisable to quit smoking.

　　4. Regular check-ups

　　It is necessary to establish the awareness of regular check-ups, and in case of suspected symptoms, seek medical attention immediately to achieve early detection and early treatment.

　　Lumbar disc herniation is a common disease, with most patients presenting with lower back pain, with an incidence rate of about 91%. Due to the stimulation of the nucleus pulposus to the outer layer of the annulus fibrosus and the posterior longitudinal ligament, lower back pain can be induced through the sinus nerve, and sometimes accompanied by buttock pain. The following examinations need to be done for patients with lumbar disc herniation:

　　1. Lumbosacral X-ray film

　　Sometimes, degenerative changes such as narrowing of the intervertebral space and hyperplasia of the vertebral body margin can be seen, which is an indirect clue. Some patients may have vertebral deviation or scoliosis. In addition, X-ray films can detect the presence of bone diseases such as tuberculosis and tumor, which has important significance for differential diagnosis.

　　2. CT examination

　　It can clearly show the location, size, shape, and the condition of compression and displacement of the nerve roots and dural sac of the intervertebral disc protrusion. At the same time, it can also show the conditions such as thickening of the vertebral lamina and yellow ligament, hypertrophy of the small joints, and stenosis of the vertebral canal and lateral recess, which has great diagnostic value for this disease and is now widely used.

　　3, Magnetic Resonance Imaging (MRI) Examination

　　MRI has no radioactive damage and is of great significance for the diagnosis of lumbar disc herniation. MRI can comprehensively observe whether the lumbar intervertebral disc is diseased, and through sagittal images of different levels and cross-sectional images of the affected intervertebral disc, it can clearly show the morphology of the intervertebral disc herniation and its relationship with the dural sac, nerve roots, and other surrounding tissues. In addition, it can also distinguish whether there are other space-occupying lesions within the spinal canal. However, it is not as good as CT in showing whether the herniated intervertebral disc is calcified.

　　4, Other

　　Electrophysiological examination (electromyography, nerve conduction velocity, and evoked potential) can assist in determining the extent and range of nerve damage, and observing the effectiveness of treatment. Laboratory tests are mainly used to exclude some diseases and play a role in differential diagnosis.

　　With the increasing incidence of lumbar disc herniation, more and more friends are aware of the serious harm caused by the disease. In order to avoid as much inconvenience and pain caused by lumbar disc herniation as possible, it is necessary to receive timely treatment after being diagnosed with the disease. If treatment is delayed due to carelessness or improper treatment, it may lead to serious conditions such as paralysis over a long period of time. Delicious medicinal diet to alleviate lumbar disc herniation:

　　1, Sanqi and Rehmannia Pork Soup

　　Ingredients: 12 grams of Sanqi crushed, 30 grams of raw earth (Rehmannia glutinosa), 4 dried dates, and 300 grams of lean pork.

　　Preparation: Place in a pot, add an appropriate amount of water, bring to a boil over high heat, then reduce to low heat and cook for 1 hour until the lean meat is tender, then add salt to taste. Drink the soup and eat the meat, 1 dose every other day. It has the function of promoting blood circulation and removing blood stasis, and relieving pain.

　　Effectiveness: Mainly for acute lumbar disc herniation with qi stagnation and blood stasis.

　　2, Euryale Ferox Porridge

　　Ingredients: 30-50 grams of euryale ferox, and 100-200 grams of glutinous rice.

　　Preparation: Place both ingredients in a pot, add water, bring to a boil, then simmer over low heat.

　　Effectiveness: Euryale ferox is sweet and mild, capable of consolidating the kidney and涩精, invigorating the spleen and stopping diarrhea, suitable for the elderly.

　　3, Yam and Chestnut Porridge

　　Ingredients: 15-30 grams of yam, 50 grams of chestnuts, 2-4 dried dates, and 100 grams of glutinous rice.

　　Preparation: Shell the chestnuts, and cook them with yam, dried dates, and glutinous rice to make porridge.

　　Effectiveness:山药is sweet and mild, capable of tonifying the spleen and stomach, benefiting the lung and kidney, especially suitable for those with qi deficiency in the spleen and kidney; however, it should not be eaten in large quantities at one time, otherwise it may cause indigestion and poor digestion.

　　4, Longan and Lotus Seed Porridge

　　Ingredients: Plain rice porridge, longan, lotus seeds, and sugar.

　　Preparation: Peel the fresh longan and soak the lotus seeds and remove the lotus core. Add the longan, lotus seeds, and sugar to the plain rice porridge and boil until well mixed.

　　Effectiveness: This porridge has the effects of invigorating the spleen and kidney, calming the mind and nourishing the heart, anti-aging, strengthening the heart, and lowering blood pressure.

　　5, Sanqi Stewed Pheasant

　　Ingredients: 2 fat pheasants (about 200 grams) with skin, head, and internal organs removed, 15 grams of Sanqi (Panax notoginseng) crushed, and 4 dried dates with seeds removed.

　　Preparation: Place all the ingredients in a slow cooker, add an appropriate amount of water, bring to a boil over high heat, then reduce to low heat and simmer for 1-2 hours. Drink the soup and eat the meat, 1 dose per day. It has the function of invigorating the body and promoting blood circulation, reducing swelling and relieving pain.

　　Effectiveness: Mainly for qi deficiency and blood stasis, as well as weak spleen and stomach in lumbar disc herniation.

　　6, Health-preserving porridge with walnuts, chestnuts, and red beans

　　Ingredients: Walnut meat 20 grams, red beans 100 grams, glutinous rice 100-200 grams.

　　Preparation: Wash the walnuts, crush them, and cook them with red beans and glutinous rice to make porridge. It can moisten the lungs and relieve cough, tonify the kidney and secure the essence, and moisten the intestines and promote defecation. However, those with phlegm fire, accumulated heat, or diarrhea should avoid eating it.

　　Effects: Adjust blood, tonify kidney and strengthen the waist, invigorate the spleen and stop diarrhea, promote blood circulation, and stop bleeding.

　　Warm Reminders:Office workers and salespeople, as well as physical laborers, are high-risk populations for lumbar disc herniation. During their work, they should combine work with rest, and pay attention to scientific lumbar twists to relieve lumbar fatigue. Especially young women who prefer to wear short clothing are very prone to lumbar wind invasion. Therefore, to protect the lumbar spine, attention should be paid to keeping the waist warm, trying not to catch a cold. Wear a lumbar support belt during the day to strengthen the protection of the lumbar and thoracic region.

　　Current research finds that most patients can be relieved or cured by non-surgical treatment. The treatment principle is not to return the degenerated and herniated intervertebral disc tissue to its original position, but to change the relative position or partially re-narrow the intervertebral disc tissue and the compressed nerve root, reduce the pressure on the nerve root, relieve the adhesion of the nerve root, eliminate the inflammation of the nerve root, and thereby relieve the symptoms. The following are the general steps of conservative treatment for lumbar disc herniation:

　　1. Lie flat on a hard board bed, prohibit lumbar movement.

　　2. Traction Reduction Method: Perform traction reduction without contraindications. First perform lumbar pelvic traction, starting with the tolerance amount, 30 minutes each time, once a day, one course every two weeks.

　　3. Massage Therapy.

　　4. Physical Therapy: Short-wave diathermy and electrical motion therapy. Short-wave diathermy: Place the plate-shaped electrode at the corresponding position of the lumbar and abdominal area, produce a feeling of warmth locally, 15 minutes each time, 20 times as one course. Electrical motion therapy: Place the electrode at the pain point, with tolerance, once a day, 40 minutes each time.

　　5. Drug Treatment: Most acute patients have severe lumbar pain, treated with Western medicine for anti-inflammatory and analgesic, dehydration therapy, temporary application of 20% mannitol injection, intravenous infusion of 10% G.S 500mL, Xueshuantong 450mg, oral administration of diclofenac sodium capsules, and simultaneous use of活血止痛capsules. Antibiotics and dexamethasone can be used according to the situation.