Tuesday, June 23, 2020

Types of lumbar disc herniation

It is often heard in life that someone is suffering from "sciatica", and many of them do not know the essence of sciatica, and some blindly wearing a "sciatica" hat causes unnecessary mental burden.

Sciatica is not the name of a disease but a symptom. The typical manifestation is pain from the buttocks along the outside of the thigh to the outside of the lower leg and ankle, which may be accompanied by weakness and numbness in the lower leg and foot. Pain can be induced and aggravated by the sciatic nerve being pulled and stimulated, such as bending down, lifting heavy objects, coughing, etc. The sciatic nerve is a large peripheral nerve in the whole body. It consists of a part of the waist 4 and waist 5, and the sacral 1-3 nerves merge in the pelvis to form the sciatic nerve. It passes through the lower edge of the sciatic foramen piriformis and exits the pelvis along the back of the thigh until the foot toe. There are many causes of sciatica, which can be summarized as: sciatica can occur in any injury or disease near the sciatic nerve itself or walking. It can be summarized into the following four categories:

(1) Trauma, such as waist fold, nerve contusion, etc.

(2) Inflammation, such as neuritis, lumbosacral tuberculosis, epidural abscess, etc.;

(3) Tumors, neurofibromas, primary or metastatic lumbosacral vertebrae, etc.;

(4) Nerve is stuck and compressed, such as lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis, etc.

Among the above-mentioned causes, the common cause of sciatica is intervertebral disc herniation, especially young adults, that is to say, if sciatica occurs in young adults, the first consideration is lumbar disc herniation.

There are five lumbar vertebrae and one sacrum. The lumbar and lumbar sacral vertebrae are connected by the intervertebral disc. The role of the intervertebral disc is to facilitate the movement of the vertebral body and restrict the excessive movement of the vertebral body. A cartilage plate is connected to the vertebral body above and below, surrounded by a fiber ring, and the nucleus pulposus in the middle is a gel-like substance. The so-called intervertebral disc herniation is that the nucleus pulposus rupture of the annulus fibrosus penetrates into the posterior spinal canal intervertebral disc.

When doing lumbar flexion and extension activities, the anterior and posterior edges of the lumbar vertebrae can produce 50g of pressure. When lifting weights from the ground, the pressure of the lumbar 4-5 intervertebral disc can be 15 times that of the original weight. When the pressure of the intervertebral disc increases to 350g on average, there is a fibrous ring rupture. Possible. It can be seen that the main reason for disc herniation is trauma, and some people have suggested that disc herniation is an immune disease that needs further research to confirm.

Due to the high degree of activity and pressure on the lumbosacral part, more than 90% of the herniated discs occur in the lumbar 4-5 and lumbar 5-sacral 1 discs. Diagnosis of lumbar disc herniation is based on recurrent sciatica. Examination may have the following signs: Often there is a special standing or walking posture of forced lumbar spine bending to the left or right. The lumbar spinous process has a midline curve of 1.5 cm and tenderness and Radial pain in the lower limbs, positive test for straight leg elevation, weakened toe flexion and extension force, dull pain in the calf and foot or inside or outside, weakened or disappeared Achilles tendon reflex, positive neck flexion test and jugular vein compression test. Lateral X-ray films showed that the lumbar vertebral physiology was reduced, the lumbar intervertebral space was narrowed, or the normal anterior width and posterior narrowing were changed to anterior and posterior equal width or anterior narrow and posterior width. In spinal angiography, the arcuate indentation of the contrast disc or the nerve heel sleeve of the prominent intervertebral disc can be seen. CT and MRI can determine the location and degree of disc herniation.

In short, the current diagnosis of disc herniation is not difficult. Prevention of lumbar intervertebral protrusion. The main method to prevent lumbar intervertebral protrusion is to prevent waist injury and strengthen the back muscle exercise. You can use the back extension method or health exercises to exercise the lower back muscles. The strong lower back muscles help stabilize the lumbar spine. Once the waist injury occurs, you should rest fully, which is conducive to wound healing and prevents herniated disc. The treatment of lumbar disc herniation is divided into two methods: conservative (non-surgical) and surgical treatment. Non-surgical treatment is suitable for patients with initial onset or early disease without extensive muscle strength, sensory disturbance, and no dysfunction of stool. Specific methods are:

(1) 4-6 weeks of bed rest in the acute phase may be expected to repay the nucleus pulposus by protruding "bulge-shaped" protrusions (partially ruptured annulus fibrosus).

(2) Lumbar traction or traction plus massage reduction method is a more effective method in conservative treatment.

(3) Correct massage and massage are conducive to treatment, and you should find an experienced doctor to prevent the brutal technique of "Jianghu Doctor" from causing secondary damage.

(4) Ozone injection, injecting different doses according to the degree and location of the lesion. This method is currently a relatively simple and safe treatment method, and more importantly, it has a good effect. It can go down ten minutes after a needle. . Pok Oi Hospital has invited the president of the European Ozone Association, Vance Li, to give lectures in August. The injection technique is more proficient and has solved the pain for many patients.

(5) Other treatments for intervertebral discs, the eight major technologies of Pok Oi Hospital become disc disease treatment supermarkets, tailor-made for patients, reasonable planning, and individual treatment of intractable disc disease.

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