Release time：2023-11-13 17:08
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Lumbar disc herniation (LDH) is a series of clinical symptoms caused by degenerative changes in the intervertebral disc or external force causing imbalance of internal and external pressure of the lumbar disc, resulting in rupture of the lumbar annulus fibrosus and protrusion of the nucleus pulposus, which stimulates and compresses the nerve roots, blood vessels, spinal cord or cauda equina in the lumbar spine.
According to the World Health Organization (WHO) report, LDH is one of the most important causes of low back and leg pain in both developed and developing countries. Most of them are adults aged 30 to 50, and the incidence rate in men is about twice that of women, which seriously affects the quality of life of patients.
1. Disease staging of lumbar disc herniation
According to clinical manifestations and visual analogue scale (VAS), LDH can be staged:
Acute phase: clinical manifestations include severe pain in the waist and legs, obvious limitation of activity, inability to stand or walk, and muscle spasms;
Remission phase: clinical manifestations include relief of pain in the waist and legs, improved activity, but still pain;
Rehabilitation phase: clinical manifestations include the basic disappearance of pain in the waist and legs, but weakness in the waist and legs, and inability to stand or walk for a long time.
2. Classification of lumbar disc herniation
Lumbar disc bulging: Lumbar disc bulging refers to the degeneration and relaxation of the intervertebral disc, with the peripheral fiber ring uniformly exceeding the edge of the vertebral endplate, the disc bulging backwards and rising on the sagittal plane of MRI, and the CT and MRI cross-sections showing a 2-3mm larger shadow than the vertebral periphery. Therefore, the words "disc bulging" appear constantly in CT and even MRI reports. Lumbar disc bulging is a pathological change of disc degeneration, which can cause low back pain and pain in both lower limbs.
Lumbar disc herniation: refers to the local rupture of the intervertebral disc annulus, the protrusion of the nucleus pulposus through the fissure of the annulus fibrosus, and the formation of a localized bulge into the spinal canal behind the vertebral body. There are quite a lot of reports of disc herniation in CT and MRI examinations, and the height of the protrusion is mostly more than 2-3mm. Whether some small protrusions can produce symptoms depends on the local situation of the spinal canal, the relationship between the protrusion and the dura mater sac and nerve course. The incidence of disc herniation in the normal population can be as high as 30%.
Lumbar disc herniation: It is a more serious type of lumbar disc herniation. Specifically, it refers to the complete protrusion of the nucleus pulposus tissue of the lumbar disc into the spinal canal through the rupture of the annulus fibrosus, which compresses the nerve roots or spinal cord, thereby causing a series of clinical symptoms, such as low back pain, radiating pain in the lower limbs, numbness, muscle weakness, etc.
Free lumbar disc: The annulus fibrosus is completely ruptured, and the fragments of the nucleus pulposus are released through the annulus fibrosus, passing through the posterior longitudinal ligament and shifting upward or downward. Some of them are free in the spinal canal, and may even be far away from the protrusion gap.
3. Common causes of lumbar disc herniation
Sedentary: Sitting for a long time, especially when working at a desk or using electronic devices, a bad sitting posture will put too much pressure on the waist, increasing the risk of lumbar muscle strain and lumbar disc herniation.
Lack of exercise: Lack of regular physical exercise, especially exercise of the lumbar and back muscles, will lead to muscle relaxation and weakness, unable to provide sufficient support for the lumbar spine, making the intervertebral disc more susceptible to damage.
Incorrect way of carrying heavy objects: Frequent lifting of heavy objects, especially using the wrong way of carrying (such as bending over to lift objects), will instantly increase the pressure on the lumbar disc, causing it to bear a load beyond the normal range. If this continues for a long time, it is easy to cause damage to the disc structure.
Bad sleeping posture: Wrong sleeping posture, such as excessively twisted posture or lying on the same side for a long time, will increase the pressure on the intervertebral disc and induce or aggravate the symptoms of lumbar herniation.
Standing for a long time: Standing under abnormal force lines for a long time without proper rest and changing posture will cause fatigue of waist muscles and increase the risk of low back pain.
Crossing legs: This seemingly normal action actually causes uneven pressure distribution between the lumbar spine and the thoracic spine. In the long run, it may cause lumbar myofascial syndrome, lumbar facet joint disorder syndrome, etc.
4. Treatment of lumbar disc herniation
The treatment of low back pain varies depending on the cause and the degree of pain. The following are some commonly used treatments:
Bed rest: In the acute stage of low back pain, proper bed rest can help relieve symptoms. It is recommended to use a hard bed or a medium-hard mattress.
Drug treatment: Non-steroidal anti-inflammatory drugs (such as ibuprofen, diclofenac, celecoxib, etc.) are often used to relieve low back pain and inflammation. Neurotrophic drugs (such as methylcobalamin tablets, vitamin B12) are also used for certain types of low back pain. Drug treatment should be carried out according to the doctor's advice.
Physical therapy: Physical therapy methods such as hot compress, cold compress, massage, acupuncture, ultrasound therapy, transcutaneous electrical nerve stimulation therapy, etc. can help relieve low back pain.
Exercise therapy: Moderate aerobic exercise (such as walking, swimming, jogging, yoga, Pilates, etc.) and waist and abdominal muscle strength training can enhance waist muscle strength and endurance, improve posture, and relieve pain.
Surgical treatment: For some severe cases of low back pain, such as lumbar disc herniation or lumbar fracture, surgical treatment may be necessary.
Traditional Chinese medicine treatment: Traditional Chinese medicine treatment such as acupuncture, massage, cupping, five animal exercises, Tai Chi, etc. also have good effects on low back pain.
5. Prevention of low back pain
Develop the right waist habits: avoid standing or sitting for a long time, and avoid excessive waist use.
Appropriate exercise: Strengthen waist and back muscle exercises, such as bridge exercises; regularly stretch the waist and legs to maintain the flexibility of muscles and ligaments.
Pay attention to the prevention and treatment of osteoporosis: Middle-aged and elderly people should pay special attention to prevent low back pain and fractures.
Treatment of knee osteoarthritis: Active treatment of knee osteoarthritis can relieve low back pain, because the aggravation of knee joint dysfunction and deformity will increase the load on the waist and aggravate lumbar disease.
Control weight: Excessive weight will increase the burden on the waist. Controlling weight through a reasonable diet and exercise can reduce the pressure on the waist.
Correct posture: Correct posture for lifting and working, and a medium-hard mattress can avoid the occurrence or aggravation of low back pain. It is recommended to wear protective gear when working continuously or in certain situations that will increase the load on the spine, and pay attention to regular relaxation.