We often encounter patients who lean forward or use their hands to support their waist, limping and walking slowly into the examination room. Their main symptoms are similar, mainly lower back pain, varying degrees of numbness and pain on one or both sides from the buttocks to the legs and feet, and abnormal skin sensation in some areas. In such a situation, it is highly likely that one accidentally falls for a common and frequently occurring disease, namely lumbar disc herniation.
1、 What is lumbar disc herniation?
It is one of the common diseases in orthopedics. This disease is mainly caused by degenerative changes in various parts of the lumbar disc (nucleus pulposus, annulus fibrosus, and cartilage), especially the nucleus pulposus. With age, strain, or external force, the annulus fibrosus of the disc ruptures, and the nucleus pulposus tissue protrudes (or prolapses) from the site of rupture into the posterior or spinal canal, causing adjacent tissues such as spinal nerve roots, spinal cord, cauda equina, etc. to be subjected to chemical stimulation or physical compression, resulting in a series of neurological symptoms such as lumbosacral pain, lower limb pain, numbness, and even urinary and fecal incontinence, incomplete paralysis of both lower limbs, etc.
2、 Main symptoms:
1. Lower back pain: Most patients with lumbar disc herniation have lower back pain. Some patients may experience it after clear sprains or injuries, but some patients do not have obvious triggering factors. The range of lower back pain is relatively wide, but mainly in the lower back and lumbosacral region, with dull pain that is sometimes severe and sometimes mild. In the acute phase, there may be tearing like sharp pain, and the pain can be reduced when lying flat. The pain worsens when sitting for a long time or bending over to move, and the pain can limit the movement of the lower back.
2. Radiative pain in one or both lower limbs: Radiative pain in the lower limbs can occur before, after, or simultaneously with the onset of lower back pain. The pain mainly extends along the buttocks, thighs, and back of the calf to the heel or dorsum of the foot, presenting as a radiating stinging sensation. In severe cases, it may present as electric shock like pain. To alleviate pain, patients often adopt protective postures such as bending the waist, hip, knee, and scoliosis. Radiative pain generally occurs in one lower limb, which is the side where the nucleus pulposus protrudes. A few patients with central protrusion may experience bilateral lower limb radiating pain, usually mild on one side and severe on the other. The direct cause of lower limb radiating pain is the stimulation of nerve roots by protrusions and their metabolites.
3. Numbness and sensory abnormalities in the lower limbs: The onset of numbness in the lower limbs generally occurs after the pain is relieved or accompanied by the mechanical compression of the proprioceptive and tactile fibers of the protruding object on the nerve roots. The area of numbness or sensory relief corresponds to the affected nerve roots. The sensory abnormalities in the lower limbs are mainly accompanied by coldness and a decrease in the temperature of the affected limb, especially at the toe tips. This is due to the stimulation of sympathetic nerve fibers in the intervertebral disc, which causes constriction of lower limb blood vessels.
4. Weakening or paralysis of muscle strength: When the protruding intervertebral disc compresses the nerve roots severely, nerve paralysis can occur, resulting in weakened muscle strength or even paralysis. This is mostly caused by lumbar disc herniation and compression paralysis of the lumbar nerve roots, manifested as a decrease in extension or flexion force, and in severe cases, foot prolapse.
5. Intermittent claudication: When the patient walks, the symptoms of lower back and leg pain worsen with the increase of walking distance. After resting for a period of time, they can walk again, and the same symptoms appear again after walking the same distance. This is due to secondary lumbar stenosis caused by lumbar disc herniation.
6. Symptoms of cauda equina: Central type lumbar disc herniation. If the protrusion is large or the spinal canal is bony, it can compress the cauda equina nerve, causing numbness, pain, and weak urination and defecation in the perineum. Women may experience urinary incontinence, and men may experience erectile dysfunction.
3、 What are the treatment methods?
（1） Conservative therapy is the preferred method for treating lumbar disc herniation, and it has significant effects on the early and middle stages of lumbar disc herniation, including traction, physical therapy, and other symptomatic and effective measures. About 90% of patients with cervical and lumbar spondylosis do not require surgical treatment, but surgery is the last line of defense and carries certain risks, which need to be treated and chosen carefully.
（2） The conditions for surgery for lumbar disc herniation are: 1. A clear diagnosis of lumbar disc herniation and failure after continuous conservative treatment for 6 months. 2. Patients with severe recurrent symptoms request surgery. 3. Sudden lumbar disc herniation causes severe and persistent root pain that cannot be relieved; Narrowing of the spinal canal due to various reasons. 4. Patients with intervertebral disc herniation combined with loss of nerve root function or dysfunction of the cauda equina, i.e. urinary and fecal incontinence, are at risk of lower limb paralysis.
4、 How to prevent lumbar disc herniation?
When carrying heavy objects, try to get your body as close to the object as possible, so that it is close to your abdomen. At the same time, you should maintain balance and not exert too much force. After bending down for a long time, do not suddenly straighten your waist. 2. Mattresses should not be excessively soft, and should be able to maintain normal physiological curvature of the spine during sleep. 3. Life should be regular, not sit for long periods of time, engage in appropriate physical exercise, purposefully strengthen the waist and back muscles, make the muscles strong and powerful, form a "muscle waist circumference", and reduce the load on the intervertebral disc. 4. Once acute lumbar sprain occurs, appropriate rest and timely treatment should be sought.