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The occurrence of lumbar disc herniation can be attributed to the simultaneous action of two internal and external factors. The intrinsic factor is mainly the degeneration of the lumbar intervertebral disc itself. External factors are mainly trauma, strain, etc. The main pathological changes are the rupture of the annulus fibrosus and the stimulation and compression caused by the herniation of the nucleus pulposus. Therefore, from the perspective of whether it can accurately reflect pathological changes, the name of lumbar disc herniation is not very accurate. However, because the name of lumbar disc herniation has been used for a long time and has been used to this day, people are very accustomed to calling it this way, so we also use this name.

Lumbar disc herniation usually causes more spinal cord prolapse in the direction of the spinal canal (i.e., toward the back), while less prolapse in the direction of the vertebral body (i.e., upward or downward). The prolapsed nucleus pulposus that ends in front of the posterior longitudinal ligament is called "herniation", while the one that passes through the posterior longitudinal ligament and enters the spinal canal is called "prolapse". According to the direction of the protrusion of the nucleus pulposus, it can be divided into: ① Unilateral type, which generally only produces symptoms on one side of the lower limb. ② Bilateral type results in bilateral lower limb symptoms. ③Central type, which can compress the cauda equina nerve, manifesting as perineal paralysis and urinary and defecation disorders.

After lumbar intervertebral disc herniation, the physiological lordosis of the spine may become straightened or scoliosis, the spinal nerve root may be damaged, the intervertebral space may narrow, the vertebral body edge bone hyperplasia, intervertebral joint degeneration and A series of changes such as spinal stenosis lead to the prolongation and recurrence of symptoms in many patients.

Generally speaking, the herniated nucleus pulposus can be reduced or partially reduced in the early stage, which is more likely in young patients with better intervertebral disc elasticity. However, many patients further exhibit self-healing defense reactions such as nucleus pulposus fibrosis or atrophy; however, ossification may also occur based on the above changes, and even lead to the formation of osteophytes at the edge of the vertebral body.

·How to treat lumbar disc herniation - Medication Guide

Analgesic drugs for lumbar disc herniation

Medical treatment can treat lumbar disc herniation Prominently plays an auxiliary symptomatic treatment role.

The severe pain caused by lumbar disc herniation not only brings unbearable pain to the patient, affects sleep and rest, but can even cause some physiological dysfunction in the patient. Therefore, appropriate analgesics can be taken before definitive treatment. Representative drugs include: Lexan, Celebrex, Diphenamine, and Tramadol.

Lexamethonone and Celebrex are new non-steroidal anti-inflammatory drugs. It is welcomed by more patients because it greatly reduces the adverse reactions to the kidneys and stomach and retains good analgesic and anti-inflammatory effects. Lesong is an imported drug from Japan. In Japan, 800,000 to 900,000 people use Lexone every day, and it has become the most prescribed anti-inflammatory and analgesic drug. Rapid pain relief is its greatest feature. However, please do not use it if you are a patient with severe heart, liver, and kidney dysfunction, severe blood system disease, or peptic ulcer.

Celebrex is a new class of anti-inflammatory and anti-rheumatic drugs. It can be used in combination with a variety of antihypertensive and diabetic drugs without significant interactions. Safe and effective to use.

You may not be familiar with ibuprofen, but you may be familiar with its extended-release capsules, FenBid. Its powerful effect in relieving patients' joint pain and neuralgia and minor side effects make it popular among patients. In addition to sustained-release capsules, ibuprofen also comes in tablets, granules, oral solutions, etc. Also use with caution in patients with gastric and duodenal ulcers.

Lumbar disc herniation is more common in middle-aged and elderly people and people who maintain fixed postures for a long time, such as office workers, computer operators, accountants, typists, teachers, drivers. These people have poor physical fitness due to long-term lack of physical exercise. Relatively weak, and their lumbar vertebrae bear static pressure for a long time. According to Huang Jiasi Surgery, when the human body is tilted forward 20 degrees in the seat, the pressure on the lumbar disc is the greatest. Therefore, the lumbar vertebrae of the "Zo Clan" people are very susceptible to lesions. In addition, the lumbar spine of workers who have been engaged in heavy physical labor for a long time or in a cold and humid environment for a long time is also very susceptible to lesions.

Lumbar disc herniation is clinically more common in people aged 20-50, accounting for about 80% of the patients. There are significantly more men than women, and more in rural areas than in cities.

It is more common in women after pregnancy and childbirth. They often experience sudden and severe low back pain and difficulty in moving. Lumbar disc herniation is common in young adults, especially in manual workers or those who sit and stand for long periods of time. There is no significant difference in the incidence between men and women. .

Except for a small number of injuries among young and middle-aged people, most of them are caused by physical strain due to people's lack of health care knowledge, lack of attention to rest, and physical strain. In particular, some drivers and copywriters often suffer from neck and shoulder discomfort, low back pain, leg pain, limb numbness and other symptoms due to incorrect sitting postures or sitting for long periods of time, which eventually lead to the occurrence of lumbar spine diseases.

According to the survey statistics of the Orthopedic Disease Prevention and Treatment Professional Committee of the China Association for the Promotion of International Medical and Healthcare Exchanges, the incidence of spondylosis among primary and secondary school students is rising rapidly. Among 2,000 samples, the incidence rate is 12; among 30-40 years old 59.1 people in the population suffer from cervical and lumbar spondylosis; among people aged 50-60, the number of patients is 71; and the incidence rate among people over 60 years old is as high as 82.

This clinical statistical result sounds a warning to people that lumbar spondylosis is quietly approaching young people.

Misunderstanding 1: Tolerating and adapting, and getting by

Lumbar spondylosis is a common and frequently-occurring disease. Many people aged 20-50 who are prone to the disease think they are young and strong and do not pay attention to the "smallness" of their bodies at all. "Sickness is a minor calamity", he did not take the discomfort in his waist seriously, did not prevent it, and did not treat it. In fact, at this time, your waist has already developed lesions unknowingly. Wait until it affects work and life before taking CT scans, examinations, and seeing experts. By then, treatment is already difficult.

Myth 2: Taking a lot of medicine and injection treatment

Currently, most patients with lumbar disc herniation take drug treatment as their first choice. However, as far as the pathogenesis of lumbar disc herniation is concerned, the compression of the nerve root by the nucleus pulposus cannot be relieved. Drug therapy is not a permanent cure and can only temporarily relieve the patient's pain. The result is a life-long investment that never ends, and will relapse if you stop taking the medicine. However, the medicines have varying degrees of toxic and side effects and are not suitable for long-term use.

"Nucleolytic surgery" uses the injection of protease drugs. Although the nucleus pulposus disappears, it does so at the expense of accelerated degeneration, causing the intervertebral disc to lose its elasticity, causing the upper and lower vertebral bodies to fall together, increasing wear and tear. It is easy to produce bone hyperplasia. In addition, other vertebral bodies will bear greater pressure, which will accelerate the degeneration of other intervertebral discs. Over time, it will also easily lead to other intervertebral disc lesions.

Myth 3. Complete surgery for treatment

According to experts, surgical treatment of lumbar disc herniation is not the first choice. Generally speaking, only conservative treatment is ineffective and the patient's pain cannot be resolved. , surgery is only needed when it seriously affects work and life. Moreover, surgery has strict indications and contraindications, and there are many complications. The lumbar spine is a part of a person's life that moves a lot. After surgery, these parts will become relatively fragile, prone to degeneration and more susceptible to injury.

Myth 4. Once there is pain, massage is enough.

Patients with lumbar disc herniation will have a history of pain for a certain period of time. Since the symptoms are mild in the initial stage, many people are accustomed to resorting to massage to relieve pain when they are in pain. In fact, massage and massage can only provide relief but cannot cure the root cause. And because many massage and massaging people lack sufficient understanding of lumbar disc herniation, they often aggravate the condition and even cause accidents. Therefore, experts remind: Doctors who choose to perform traction and massage treatments should first have a certain understanding of lumbar disc herniation, and at the same time understand the onset stages of the disease. It does not mean that the longer the massage time, the more significant the therapeutic effect will be, but massage The technique, weight, etc. are also very important.

1. Traction treatment of lumbar disc herniation

The traction therapy of lumbar disc herniation is to apply the relationship between the action force and the reaction force in mechanics, through a special traction device. A method to achieve therapeutic goals.

Main functions:

(1) It plays the role of fixing and braking the waist: during traction, under the balance state of the action force and the reaction force, the pulled waist is in a state of balance. Compared with the fixed normal alignment state, the range and amplitude of movement of the waist are further restricted than when resting in bed and wearing a waist girdle, in order to reduce or eliminate local congestion, exudation, edema and other inflammatory reactions.

(2) Relax the muscles of the lower back: Lumbar disc herniation, due to the compression or stimulation of the spinal nerves, is often accompanied by muscle spasm in the lower back, which not only causes pain symptoms in the waist, but also causes The alignment of the lumbar spine is incorrect. Traction therapy can gradually relax the low back muscles and relieve muscle spasms.

(3) Restore the normal alignment of the lumbar spine: During traction, if the patient's lumbar spine is placed in a physiological curve, as the traction time increases, the abnormal alignment can gradually return to normal.

(4) Improve the relationship between the protrusion and the nerve: For patients with mild or early-stage lumbar disc herniation, traction therapy can gradually retract the intervertebral space, which is beneficial to the reduction of the protrusion. . For patients with a relatively long course of disease, traction can retract the adhesions, contracted ligaments, and joint capsules to widen the spinal canal space accordingly. The narrow intervertebral foramina on both sides can also be retracted at the same time, thereby alleviating or eliminating the pain. Nerve root compression and stimulation have a good effect on reducing numbness and pain in the lower limbs

2. Physical therapy in the acute phase of lumbar disc herniation

Physical therapies commonly used in the acute phase include:

(1) Short wave and ultra-short wave therapy: In the early stages of the disease, in order to improve the blood circulation of the affected area, eliminate possible inflammatory reactions such as exudation and edema, and reduce the risk of nerve root compression or stimulation. For pain, short-wave and ultra-short-wave electrotherapy is generally used. During treatment, the two electrode plates can be opposite to each other in the lumbosacral region or juxtaposed in the lumbosacral region and the back of the affected leg. Warm heat, once a day, 20-40 minutes each time. 15-20 times is a course of treatment.

(2) Intermittent electrotherapy: Small round electrodes can be used to treat the lumbosacral area and along the ischial meridian point by point. Dense wave for 2-5 minutes; sparse wave for 5 minutes; intermittent wave treatment for 5 minutes. Rising wave for 5 minutes. 1-2 times a day, 15-20 times is a course of treatment.

(3) Super-stimulating current therapy: Two 8*12 square centimeter electrodes can be used, one is placed horizontally on the sacral area, and the other is placed vertically on the waist. After turning on the power, drain the electricity as soon as possible. Adjust to 8-12 mA. After the strong electrification feeling disappears, increase the power to 18-23 mA within 2-7 minutes. Each treatment lasts for 15 minutes. Once a day or every other day, if effective, the treatment can be continued to 6-12 times. 3. Western-style manual treatment of lumbar disc herniation

This manual treatment is a treatment method that uses the operator's hands to push, pull, rotate and other passive activities on the patient's bone and joints. . It is based on the functional anatomy of bone and joints, guided by the biomechanical principles of bone and joint activity, and adopts corresponding techniques to improve the patient's bone and joint functions and relieve clinical symptoms.

For lumbar disc herniation, Western techniques use different auxiliary movements or passive physiological movements to push and vibrate the lumbar spinous process or joint side, as well as rotate and stretch the lumbar vertebrae. During the operation, Tongjin uses several techniques and applies four levels of intensity: 1, 2, 3, and 4 according to the patient's condition. Among them, light manipulation can be used for patients with acute lumbar disc herniation, severe pain, and high stress; heavy manipulation can be used for patients with chronic lumbar disc herniation or with impaired joint mobility. The time generally lasts for 45 seconds, 60 seconds or 90 seconds at a frequency of 1-2 times per second. Intensity and time can be selected as appropriate. Each course of treatment is 5-10 times, with a break of 10-20 days between 2 courses.

4. Drug treatment of lumbar disc herniation

Drug treatment of lumbar disc herniation is generally only used as an auxiliary treatment with the main purpose of relieving symptoms.

(1) For patients whose pain symptoms are intolerable and cannot lie down or sleep, they can be given oral anti-inflammatory and analgesic drugs; or antispasmodic and analgesic tincture can be applied externally to relieve local pain.

Try to reduce the patient's pain as much as possible and facilitate the implementation of other rehabilitation treatments.

(2) In the acute stage of lumbar disc herniation, the edema of the spinal nerve root sleeve is more obvious, which is not only one of the main causes of severe pain, but can also cause secondary arachnoid adhesion. In order to eliminate local reactive edema, intravenous infusion of steroid drugs, diuretics such as hydrochlorothiazide, and intravenous pressure infusion of dehydrating agents such as mannitol can be used.

(3) For patients with lumbar disc herniation based on degenerative changes, especially elderly patients, they can take chondroitin sulfate A (Kundelin), 3 times a day, 8 grams each time -12 tablets, taken continuously for about 1 month; or you can use compound chondroitin tablets, the main ingredients of which are chondroitin sulfate A 75 mg, aconite extract (equivalent to 250 mg of crude drug), white peony root extract (equivalent to 40 mg of crude drug) ), licorice extract 20 mg. The usage and dosage are the same as chondroitin sulfate A. If the patient has different degrees of muscle atrophy after suffering from lumbar disc herniation, vitamin E can be taken orally, 300 mg per day, divided into 1 or 3 times.

5. Local sealing therapy for lumbar disc herniation

There are two types of local sealing therapy for lumbar disc herniation: acupoint sealing and local and regional sealing.

(1) Acupoint sealing: It has the comprehensive therapeutic effect of acupuncture and drugs. Therefore, it has a more obvious analgesic effect than simple acupuncture or simple drug treatment. Commonly used closed acupoints include Sanjiaoshu, Shenshu, Dachangshu, Zhishi, Zusanli, Huantiao, Weizhong, Chengshan and other acupoints. Commonly used methods: 1. 2. Add 4 ml of lucaine hydrochloride injection and 1 ml of prednisolone acetate. After mixing, inject into 3-4 of the above acupoints and seal them once every 5-7 days. 3-5 times constitute a course of treatment. 2. Take 1-3 ml of vitamin B12 injection and inject it into 3-4 of the above-mentioned acupuncture points. Closed once a day. 10 times constitute a course of treatment. 3. 2-4 ml of 5% glucose or 30% salvia miltiorrhiza solution, dispense into 3-4 of the above acupoints, and seal once a day or every other day. 10-15 times is a course of treatment. In addition, vitamin B1 and compound angelica liquid are also used as sealing fluids to seal acupoints for lumbar disc herniation.

(2) Local and regional closure: It can be divided into superficial and deep closure: 1. Superficial closure: The closure range includes the lumbar dorsal fascia, the origin and insertion point of the psoas muscle, and the supraspinal ligament and interspinous ligament. It is generally required to combine tenderness points and precise anatomical parts.

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