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Minimally invasive treatment of disc herniation, disc protrusion minimally invasive surgery
Cervical disc disease is more common clinical disease of the spine, mainly due to cervical disc nucleus, annulus, cartilage, especially the nucleus, the occurrence of different degrees of degenerative diseases, the role of the external factors, lead to rupture of intervertebral disc, nucleus pulposus from the rupture or prolapse of the spinal canal at the prominent, resulting in compression of spinal nerve root and spinal cord, causing headache, dizziness; palpitations, chest tightness; neck soreness, limited mobility; shoulder pain, upper limb pain and other symptoms and signs of numbness, severe enough to cause life-threatening high paraplegia. Is more commonly used minimally invasive treatment of cervical disc disease: 1, cervical disc herniation of nucleus pulposus chemical dissolution technique; 2, cervical disc herniation Percutaneous discectomy; 3, ozone percutaneous ablation of cervical disc herniation surgery; 4, microscope or endoscope-assisted microscopic anterior cervical decompression; 5, microscope or endoscope-assisted microscopic anterior cervical decompression, fusion, internal fixation; 6, microscope or endoscope Posterior-assisted decompression under the other. Cervical disc herniation and then three as the method of minimally invasive surgery has achieved good clinical efficacy. Thoracic disc herniation is relatively small, the detection rate of thoracic disc herniation is relatively low, the symptoms are not typical of other reasons, prone to misdiagnosis and missed diagnosis. Therefore, with the following conditions should be alert to the possibility of thoracic disc herniation: 1, progressive lower extremity numbness persons; 2, a sense of who belted chest and abdomen; 3, urine and sexual dysfunction; 4, ribs neuralgia among those; 5, recurrent low back pain, chest discomfort and so on. Is more commonly used treatment for thoracic disc herniation: 1, all posterior decompression laminectomy or both anterior and lateral anterior discectomy; 2, the lateral anterior thoracic discectomy ; 3, the rear side approach (removal of the transverse process and rib) resection of thoracic intervertebral disc; 4, posterior decompression laminectomy whole rear side of thoracic discectomy; 5 thoracoscopic thoracic discectomy; 6 posterior thoracic endoscopic discectomy disc. And one of thoracoscopic thoracic discectomy as a minimally invasive method of thoracic disc herniation, have broad application prospects. Lumbar disc herniation is a common and frequently-occurring bone is the most common cause of low back pain, which is due to disc degeneration, herniated nucleus or prolapse, nerve root and cauda equina compression caused by a clinical syndrome. Most patients with lumbar disc herniation by bed rest, lumbar traction, massage, physical therapy and other conservative treatment. Lumbar intervertebral disc herniation minimally invasive treatmen
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After puberty, the body appears degeneration of various tissues, in which the change occurred earlier disc, the main change is the nucleus dehydration, after the disc loses its normal elasticity and tension, on this basis, the heavy trauma or repeated repeated the obvious damage, resulting in weak or ruptured annulus, the nucleus is highlighted by the department, nerve root injury caused by nerve root signs; also highlighted by the central back, cauda equina compression, resulting in urine barrier. Such as the annulus completely broken, shattered nucleus pulposus into the spinal canal, can cause extensive damage to the cauda equina. As a major lower back negative, activities and more, it highlights occurred in the lumbar 4-5 and lumbar 5 - S1 gap. Therefore, more often said that lumbar disc herniation, in fact, the cervical, thoracic disc between those, too, can highlight, but the signs and symptoms, and treatment is different.
Total disc treatment conservative treatment principle is to first consider the conservative treatment fails and then consider surgery.
In recent years, the international method of treatment of intervertebral disc with involvement made very great progress, including superoxide plasma treatment, collagenase treatment, so as to better efficacy, less pain, safe and complications, rapid recovery and greatly reduce the cost of surgery other notable features has been warmly welcomed by the majority of patients.
Symptoms of disc herniation
Back pain can be caused by a muscle strain and other causes, the most common cause when the number of disc disease. Bulging disc or chronic pain caused by a relatively fixed position, broad and imprecise, the pain disappeared slow and easy to relapse. This is due to ligaments, tendons, periosteum and joint surrounding tissue is mesoderm structural organization, are extremely sensitive to pain stimuli, location, deep and raw during embryonic development and regional distribution of joints - To reason.
Cervical disc generally to a lesser extent. Prominent or severe prolapse, are rare and more non-severe pain. Few have serious implications for those who work or live. The lumbar disc herniation caused by acute low back pain, often more severe level, individual patients have torn unbearable, lose the feeling. More common in disc sciatic nerve root compression in patients with acute exacerbation.
95% of lumbar disc herniation in lumbar 4-5 and lumbar 5 l of a sacral intervertebral space, most of the patients with sciatic nerve of leg pain symptoms, associated with low back pain, some patients showed the device sciatica. Lower back pain can start with the beginning of the gradual emergence of leg pain. Low back pain can also occur simultaneously. Appears first, and then leg pain or low back pain. Varying degree of severity of pain, the light still capable to keep working, and might feel restless, or even pain.
Intervertebral disc herniation is another common symptom of the patient. Patients with cervical disc herniation often appear stiff shoulder and neck pain and arm numbness. Decreased muscle strength, by the turn of cervical those patients with incomplete tetraplegia or different degrees of sensory dysfunction. Top nerve compression in the main town there are also cancer of the forearm and hand feel diminished. Lumbar disc herniation patients often lower extremity, foot, toes or numbness in the saddle area. Numb the skin can be manifested as decreased sense of touch and pain subside. Co-exist with pain, may also appear alone, is the factory nerve root compression after disc-human transmission of nerve fibers results. Whether surgery or other treatment, numbness, pain recovery than the recovery rate is much slower, and some even for years or for life exist.
Sacral lumbar disc herniation can cause hip or leg pain, numbness, increased the emergence of a limp when walking, crouching or bed rest, the symptoms were relieved or disappeared. The essence of claudication pain in patients in order to reduce the self-protective actions taken way. Because of claudication caused by nerve root compression after hyperemia, edema, inflammatory changes in lower extremity arterial blood flow increased call Tim moving, and appears slightly poor venous return of blood stasis, vasodilatation, increased nerve root compression and the small oxygen level, causing increased pain's sake. The intermittent claudication, lumbar disc herniation and other causes of spinal stenosis can cause, should pay attention to identification.
4, limb coldness
Intervertebral herniation deposited body fat patients often complained of cold. Affected nerve territories and consistent. Cervical disc hernia asked more than reflected in the lateral shoulder and upper extremity. Lumbar disc herniation in the lower extremities more than posterolateral, dorsal toe especially common, and some can be limited to the outside of the thigh or leg of a local. This is the highlight of the disc to stimulate paravertebral sympathetic fibers, limb peripheral arterial vasoconstriction results.
5, cauda equina syndrome
Large central lumbar disc herniation, cauda equina within the dural sac compression, causing severe pain, bilateral sciatica or around the turn; perineal numbness and pain disappear: weakness or bowel control, urinary retention or incontinence, and urine dysfunction; lower extremity weakness, Mu toe dorsiflexion or plantar flexion weakness, paralysis and even failure symptoms such as foot drop, individual men may present with impotence or sexual dysfunction and other symptoms. Treatment of vertebral disc hernia disc is due to bad living habits and work habits caused by poor sitting, standing and bending over or heavy manual labor is the long-term causes of morbidity. Herniated disk compression of nerve, there is a numb, swollen, weakness, pain symptoms. Lift the highlight is the treatment of nerve root compression. Depends on what kind of treatment with different pathological stages of disease and clinical performance.
(A) Conservative treatment:
Conservative treatment includes the use of medication, topical medication, physical therapy and diet and so on.
1, drug treatment:
â‘´ drug treatment of lumbar disc herniation (TCD)
ã€Methodã€‘ blood Shujin.
1. Kidney Decoction main square (Zhao Zhuquan "Great Traumatology")
Prescription: Rehmannia lO g, Eucommia 3 grams, 3 grams medlar, breaking paper lO g, dodder seed 10 g, Angelica Last 3 grams, 3 grams of myrrh, dogwood 3 grams, 2 grams of saffron, independent living, 3 grams, Cistanche 3 grams. Shuijianbi day one.
If the radiating pain was significantly lower limbs were, plus Dragon of 12 grams, 15 grams of Clematis. Pain worse, plus 5 grams of frankincense, Asarum 5 grams.
2. Proprietary small active pills, oral, per 1 pill, 2 times a day.
ã€Methodã€‘ nourishing the liver and kidney, numbness active.
1. Main side Duhuojisheng soup (Sun Ssu "Qian")
Prescription: independent living 6 grams, 18 grams Loranthaceae, Gentiana 12 grams, wind 6 grams, Chuanxiong 6 g, 6 g Achyranthes, Eucommia 12 grams, angelica 12 g, Poria 12 grams, Codonopsis 12 grams, 15 grams Rehmannia , 10 grams of white peony root, Asarum 3 grams, 3 grams of licorice, cinnamon, 2 grams (fan red). Shuijianbi day one.
2. â‘ Tianma medicine tablets, orally, each for 3 to 5 tablets, 3 times a day. â‘¡ Zhuanggu joint pills, orally, every 6 grams, 2 times a day, morning and evening after meals.
Acupuncture treatment of lumbar disc herniation acupoints: Shenshu, ring jump, Venezuela, Yin door, Yang Ling Quan, Cheng-shan, hanging bell, Ashi points. By reducing method, 1 day, 10 times as a course of treatment.
Lumbar disc herniation in patients with acute exercise activities should be strictly in bed for 3 weeks. Before and after massage should stay in bed, massage bed for two weeks after the general. Symptoms disappeared, you can get up under the protection of activities in the waist. Pain relief, you should start exercising lower back muscles, and the horizontal bar suspension front and rear leg swing exercises and so on.
Medicine on oral medications, please refer to http://www.kbyy.net/html/20077/823.htm
There are closed â‘´ local drug treatment:
Drug therapy is the closure of local anesthetic drugs by injection for nerve root closed spinal closed sacral canal being closed, is now the most common sacral drip method, saline and local anesthetic drugs, hormones, drugs and other neurotrophic according to different ratio drops by caudal epidural injection, played to eliminate the role of nerve root edema and inflammation, for severe acute pain patients, pain results have been very good.
â‘µ external use of lumbar disc herniation
Including ointments, topical herbal medicine, drug plus infrared import, drug plus iontophoresis, through methods such as traditional Chinese medicine targeted drugs, through blood circulation, relieve pain and other principles by reducing nerve pain caused by lumbar disc herniation, and then cured in some patients.
2, physical therapy lumbar disc herniation
Many methods of physical therapy, general hospitals and rehabilitation physiotherapy and other departments have specialized physical therapy equipment. Physical therapy include: massage, traction, three-dimensional traction, infrared radiation, acupuncture, cupping, electroacupuncture, intermediate frequency electrotherapy, magnetic therapy . so different and must. We recommend the use of several physical therapy methods, the results were better. Massage (also called manual reduction), the Beijing 301 Hospital, Professor Feng Tianyou's authority is manipulative reduction; traction and three-dimensional traction, is now the longest hospital with non-surgical treatment for disc bulge and mild prominence patients, we recommend use of traction, but the highlight of patients is huge, or herniated disc is not recommended for traction. Other physical therapy no contraindications, can be chosen at random.
In recent years, the "little knife" therapy, for relief of lumbar disc pain, piriformis adhesion, the effect is good.
3. Lumbar disc in place of therapy.
Use of natural saw tooth shark cartilage powder, the peak recovery of human lumbar annulus fibrosus cartilage regeneration after a 80, the advanced countries for the lumbar disc of the new medical attempt. In Europe, saw the peak of the extract of shark teeth have been identified as the drugs in the United States, OAM (Alternative Medical Services) is also the place of shark cartilage as a part of medical research and popular, and Japan is even more direct use of natural peak saw tooth shark cartilage powder as a substitute for the medical part of the clinical widely used in lumbar disc herniation, and because no side effects and won the hearts of the natural, and 7.5g / day dosage of shark cartilage or the popularity of the Japanese Association of a statistical data. Ten years of clinical results confirm the peak saw tooth shark cartilage powder, the role of human cartilage regeneration, completely overcome the human lumbar intervertebral disc has brought a bright dawn.
Method: natural saw tooth shark cartilage powder peak by use of frozen crushed
Usage: 3 times a day, a 2.5g
Include: minimally invasive endoscopic disc surgery, intervertebral disc discectomy)
Surgical indications are:
â‘ non-surgical treatment fails or relapse, the symptoms of work and life are heavier.
â‘¡ nerve injury symptoms, extensive, or even worse, suspected ruptured intervertebral disc entirely to the spinal nucleus fragments were outstanding.
â‘¢ a toilet central lumbar disc dysfunction.
â‘£ with obvious by lumbar spinal stenosis.
Preoperative preparation including the X-ray positioning method is tenderness, radiating pain was at the draw with a blue mark in the area with plastic sheets fixed a metal tag, lumbar spine X-ray film for intraoperative reference.
Surgery under local anesthesia, epidural anesthesia can also be implemented. Removal of the affected part of the yellow ligament and the upper and lower part of the lamina, and softly spinal nerve root retractor to expose the herniated disc, highlighted by long-handled knife circumcision removed after the Department of the annulus, the pituitary clamp inserted into the intervertebral space to In addition to the degradation of the residual nucleus pulposus, wash the wound to stop bleeding after the suture. Operation must be meticulous attention to intraoperative bleeding, to prevent nerve damage, spinal canal after injection of gentamicin to prevent disc space infection, before closing the wound, place rubber tube drainage.
Surgery generally revealed a disc space, but if the preoperative diagnosis of two herniated nucleus revealed no abnormality or a can and then exposed another gap. Lumbar stenosis, in addition for discectomy, it should be done under the full spinal stenosis decompression. Adopted by Department of fenestration or laminectomy laminectomy surgery method does not affect the stability of the spine. After 3 world in their movements, and rapid functional recovery, 2 to 3 months later able to resume light work. Within six months should be avoided after heavy physical labor.
Minimally invasive endoscopic disc surgery, intervertebral disc discectomy, see the http://www.kbyy.net/default.asp
(C) intervention (including: collagenase technique, ozone injection, percutaneous laser disc decompression PLDD, ultra-low temperature ablation)
PLDD high-energy laser local biological effects, namely combustion, vaporization, degeneration, and solidified the role of the intervertebral disc will highlight the "removal of out." Conger Bingbian disc to reduce the internal pressure, Huisutuchu neck, lumbar disc, the lifting of its spinal cord or nerve root compression and restore its normal physiological function of the role in removing the disc caused by patients because of the waist, leg pain, numbness and sensory and / or clinical symptoms of motor dysfunction.
The principle of collagenase technique: human intervertebral disc is composed of water, fibrous tissue, the material composition of proteoglycan, the full name of collagenase enzymes dissolve collagen, its role in the dissolution of nucleus pulposus proteoglycan, the disc volume changes small, to reduce or lift the nerve compression
Ozone injection, ozone is the role of high concentrations of O3 has a very strong oxidizing ability, as well as anti-inflammatory and analgesic effect. It is injected into the nucleus pulposus prominent within the nucleus pulposus can be instantaneous oxidation and destruction of proteoglycan within the nucleus pulposus cells, so that the function of proteoglycan loss, decreased proteoglycan cells, nucleus pulposus of the osmotic pressure is not maintained, lead to water loss and atrophy, thereby reducing the intradiscal pressure to eliminate the symptoms, to achieve the purpose of treatment.
Ultra-low temperature melting, low-temperature state is the shrinkage of intervertebral disc method to achieve therapeutic purposes.
Present a variety of treatments for lumbar disc pros and cons, please refer to: http://www.kbyy.com/html/200611/28/20061128162353_2.htm Edit this section | Back to the top of the lumbar disc hernia health (1) lying in bed requires a hard bed. Specifically, is the wood on the bed mattress or cushion thin, hard beds can also be brown.
(2) patient supine, it can at the waist plus a thin pad or make knee, hip flexion to maintain a certain, this will enable the muscles to fully relax. Prone position, the mattress should be flat, so as to avoid excessive lumbar extension.
(3) to strictly adhere to the bed rest. Even in remission after a period of time out of bed wearing waist, can not make any of lumbar flexion movement. If patients can not adhere to the inconvenience of living life in bed, it will affect the efficacy.
(4) bed rest is the most difficult to adhere to the great in bed, urinate. If the patient can not accept the supine position large, urine, can be helped by people with crutches or Shimoji go to the bathroom. Should not sit up in bed stool, because when the waist over-flexion, the intervertebral disc protrusion after more.
Differential diagnosis of disc herniation
Lumbar disc herniation is a serious ability to affect people working and living common disease. Occurred mainly in the age of 20 to 50 young adults between the ages of people, as a degenerative disease. Its incidence continuing to lumbar disc back into the main pathology, trauma to the pathogenesis of incentives. Lumbar disc herniation in 20 years of age also occur, which is called the adolescent lumbar disc herniation, the incidence rate is about 1% of adults to 6%. Differentiated with intervertebral disc disease are:
1. Pelvic outlet syndrome
Pelvic outlet syndrome is when the sciatic nerve was stimulated by the export or pelvic pressure produced by symptom cluster, the clinical manifestations of sciatic nerve irritation, starting at the hip pain along the sciatic nerve of radioactive walking, accompanied by the movement at its disposal area , sensory or reflex disorders. Can be slow onset of acute, multiple trauma, fatigue, cold or moisture history. Long course was intermittent ups and downs when seizures. Mostly unilateral disease, and early hip dull pain, soreness or heaviness, or sometimes show severe sharp pain. Pain in the rear of the thigh, posterolateral calf radiation, but few reached the bottom of the heel and foot, and mostly no clear root boundaries. Walking can aggravate the pain, or intermittent claudication occurred.
2. Gluteal strain
Gluteal muscle injury can cause acute muscle spasm, but the tender points in the lateral posterior superior iliac spine, the Council seal to the immediate elimination of symptoms.
3. Interspinous ligament strain
Is a common cause of low back pain is one of the general performance of lumbar pain for the powerless nowadays bend over, bend over straight after the difficulties and local pain.
4. Sacroiliac joint strain.
Clinical manifestations of persistent local pain, not weight bearing activities increase, turning difficult.
5. Cutaneous nerve entrapment syndrome
Cutaneous nerve in the hole through the deep fascia are stimulated or compression can produce a range of symptoms. Clinical manifestations of low back pain and hip pain can spread to the thigh and popliteal fossa, but rarely involves the lower leg; in the posterior superior iliac spine under the outer edge of the iliac crest above the obvious tenderness, and sometimes palpable nodule or small cord lipoma ; may be associated with gluteal muscle spasm. Partially closed to the immediate elimination of pain.
6. The third lumbar transverse process syndrome
In the middle of the third lumbar spine, the transverse process the longest stretch back curvature, number of abdominal muscle and fascia back on it attached to form a hub and lumbar stress center. Therefore, vulnerable to traction injury of the muscle fascia. Rear tip of the third lumbar transverse process close to the second lumbar nerve root after the branch, when the lumbar flexion and lateral bending to the right, they are vulnerable to stretch and wear an extent which rendered its disposal area to pain, numbness and other symptoms; and before the branch can involve pain caused by radiation, affecting the hip and thigh front side, a small number of radiation to the perineum. The third lumbar transverse process syndrome may slow the onset can be acute and may have a history of trauma. Edit entry Open Category:
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Introduction to Human Pathology after puberty appears degeneration of various tissues, in which the change occurred earlier disc, the main change is the nucleus dehydration, after the disc loses its normal elasticity and tension, on the basis of the trauma or the heavier several anti-
Disc herniation is not obvious injury rehabilitation, resulting in weak or broken annulus, nucleus is highlighted by the department, nerve root injury caused by nerve root signs; also highlighted by the central back, cauda equina compression, resulting in bowel and bladder disorders . Such as the annulus completely broken, shattered nucleus pulposus into the spinal canal, can cause extensive damage to the cauda equina. As a major lower back negative, activities and more, it highlights occurred in the lumbar 4-5 and lumbar 5 - S1 gap. Therefore, more often said that lumbar disc herniation, in fact, the cervical, thoracic disc between those, too, can highlight, but the signs and symptoms, and treatment is different. Total disc treatment conservative treatment principle is to first consider the conservative treatment fails and then consider surgery. Causes a disease, abdominal pressure, such as severe coughing, constipation, hard bowel movements and so on. 2, the waist position properly, when the waist is in flexion, such as easy to induce a sudden rotation of the nucleus to highlight 3, a sudden weight, in the absence of adequate preparation, the sudden increase in load to the waist, could easily cause a herniated nucleus. 4, waist injury, acute trauma can affect annulus, cartilage and other structures, and
Degenerative disc herniation of the nucleus has led outstanding. 5, occupational factors, such as car seats and a long period of bumps the driver state, easy to induce disc. Treatment for surgical treatment, interventional therapy, conservative treatment: surgical treatment surgical treatment, the openness of the patient to eliminate herniated disc surgery in order to achieve the purpose of healing. Although the results are obvious, but surgery is often difficult, extremely dangerous, and a larger wound, and some even affect the stability of the spine, and may leave after-effects, patients are often afraid of surgery. Postoperative recovery period is usually 3 months, serious impact on the patient's life, work and study. The key focus is to lift the nerve root irritation or compression, elimination of nerve inflammation, promote nerve repair, which is characterized by quick. However, big investment, risk, and there are strict adaptation of clinical symptoms: severe pain, after a long non-surgical treatment does not relieve; disc herniation large or adhesions, calcification caused lateral recess spinal canal stenosis (non-yellow ligament hypertrophy other muscle
Disc herniation stenosis) severe; nerve root irritation or compression caused by vascular disorders of lower limb muscle blood Committee atrophy, muscle strength decreased significantly, of course, there are surgical infection, nerve injury, nerve fascia and other fibrous scar tissue formation so that nerve root adhesion, causing "recurrent postoperative pain"; and lumbar spine stability is bad, cause chronic back pain, weather changes reflect the increase or other consequences. Interventional therapy intervention therapy, drug chemical dissolution prominent nucleus, the therapy for 30 years, the nature of the chemical substances react with the disc tissue so that the organization of nerve disc in the dissolution, absorption, excretion and elimination of forced or symptoms. The beginning of the drug is papain, from the clinical side effects due to, is now out of the 60 scholars of American treatment of intervertebral disc by injection of collagenase, collagenase preparations in 1973 for Pharmacological Research, studies have shown that collagenase in physiological pH and temperature can chosen ones of the structure of the hydrolysis of collagen within the disc structure (in the disc annulus in the dry weight of about 50 /, 20/-30 total dry weight of nucleus pulposus), when the disc water content decreased with the age factor, the corresponding collagen protein content increased. Collagenase treatment so the dissolution of collagen injections to reduce the disc size, to reduce or lift the stimulation of nerve tissue, oppression, clinical symptoms were relieved the pain, but one thing positive is that he will not dissolve the surrounding nerves and other tissues, bone spurs and so on, check against therapy clinical excellent rate of 77 per cent, ten years 23 per cent recurrence rate, therefore, the clinical diagnosis of the most used Imageology side disc type and lateral lumbar disc herniation associated with lumbar management, narrow patients; patients with lumbar disc herniation, calcification, free type, prolapse type, sequestra-type persons; cauda equina showed severely impaired bowel and bladder function; diabetes, cancer, mental illness neurosis and other serious organic disease and skin allergies, pregnant women. - Conservative treatment conservative treatment includes bed rest, medication, traction, massage, acupuncture and other closure method, suitable for initial issuance or mild cases. The therapy aims to highlight the parts back to promote mobility, improve local blood circulation, increase the disc space to relieve the pressure on the nerve root stimulation, but this therapy can not completely eliminate the majority of herniated disc and back satisfied. At present, with considerable research strength of institutions, require conservative treatment in combination with other treatment at the same time, in order to obtain superior results. Ozone Therapy Ozone dissolution characteristics of patients with strong oxidizing ability, into the prominent nucleus pulposus,
Collagenase technique for oxidation and decomposition of dissolved disc nucleus pulposus proteoglycan and other molecules within the polymer, the nucleus pulposus to shrink water loss, thereby reducing the intradiscal pressure to eliminate the pressure on the nerve root, nerve root to improve aseptic inflammation for therapeutic purposes, the symptoms can be eliminated. The organizational structure of ozone on the other without any damage. Ozone can be injected into the paraspinal lumbar muscle strain to eliminate. Ozone treatment of lumbar disc herniation advantages: 1, high safety factor. Under the CT location, fine needle aspiration under local anesthesia (22 ~ 24G, diameter <1mm), puncture accurate, and flexible. 2, minimally invasive treatment of risk, no pain. Than in the conservative treatment is effective, while eliminating the pain of surgery. 3, high efficacy, treatment of disc herniation, usually a single injection of 1 or 2 times, quick. 4, no allergic reactions and other severe complications, ozone itself is a disinfectant, the chances of infection is very low. 5, the injection of ozone in the disc around the same time within the organization, can treat neck muscle strain. 6, aged to adapt to a wider scope, the operation is safe for elderly patients. 7, is currently recognized as exempt from both the surgical treatment of disc herniation has a good effect and the best means. Indications 1, persistent low back pain patients, claudication, etc., associated with nerve root compression signs such as straight leg raising test was positive. 2, the CT or MRI diagnosed as intervertebral disc, imaging findings and clinical symptoms consistent. 3, 4 weeks after conservative treatment ineffective. 4, conservative treatment, but repeated illness symptoms were eased. 5, surgery or other treatment can be considered poorly dissolved O3 surgery. Contraindications: 1, bony spinal canal stenosis. 2, facet hypertrophy with lateral recess stenosis, yellow ligament hypertrophy spinal stenosis. 3, disc calcification occurred. 4, combined cauda equina compression syndrome, such as bowel and bladder dysfunction. 5, severe spondylolisthesis. 6, hemorrhagic disease. 7, spinal or other spinal diseases such as spinal tumors, vertebral metastases and so on. 8, severe liver and kidney dysfunction. Disc surgery collagenase 1, collagenase technique described percutaneous technique is to inject collagenase intervertebral disc disease, intervertebral disc protrusion in the degradation, so as to eliminate the symptoms of an intervention therapy. Collagenase or collagenase, which can effectively dissolve the nucleus pulposus and annulus fibrosus collagen â… â…¡, so reduced to the amino acids and is absorbed by the body without destroying tissue cells and nerve cells. On the HB, lactic acid protein, keratin sulfate and other protein without damage. Collagenase reaction time was 18-24 hours. Solute to be absorbed for 2 weeks after surgery scoliosis, straight leg raising angle increases, paravertebral tenderness reduce appeared earlier. Lower limb weakness and numbness nerve recovery slower. Note to accurately collagenase
Herniation into the prominent position, to achieve effective and efficient degradation of disc herniation, efficacy improved significantly. Excellent and good rate of 85% or more. Between the nuclear collagenase technique between conservative treatment and surgical treatment, there is a trauma, the effect is reliable, and complications less features. Even if conservative treatment fails does not affect the treatment and surgery. Therefore, at home and abroad has become the most effective treatment of disc herniation in one of the means. 2, the technical characteristics with no surgery, trauma, quicker recovery, good curative effect, short cycle, high security and so on. Disc herniation is one of the methods involved in the efficacy of routine. 3, methods of operation at the injection site is divided into: intervertebral disc, the prominence at the (internal / ambient) and joint injections. Way by puncture points: via security triangle, the sacral hiatus, the midline after spine, the intervertebral foramen, the external lamina notch (anatomy this location is: under the pedicle notch), and by a small medial margin (anatomical location for this: the medial edge of lamina gap) and so on. 4, circumscribed by the lamina lumbar radiographs under way, the chip on the anteroposterior midpoint of the lamina outside the notch as the A point A point will be the horizontal line through the intersection with the spinous process as a B point on the spinous process edge as a C point, measuring the length of Management AB and BC. According to BC to determine the length of surface B points. A surface based on point to determine the length of AB, that the needle point. After local anesthesia disinfection draped with a long needle 7, the needle points vertically through the needle, 5-10 degrees tilt inward direct lamina, measuring the depth of the needle, find the notch and the outer lamina touch yellow ligament, edge pressure side of the needle slowly, directly or vertebral foramen inside the mouth, outside the mouth or inside and outside the mouth of the junction, the syringe was vacuum suction, no blood and cerebrospinal fluid, injection of air without resistance. Injection of 1-2ml direct economic losses caused by non-ionic film agent, the pivot or lateral radiograph is confirmed, determine the tip located in the intervertebral foramen, spinal nerve root sleeve at that injection of 1.3% lidocaine hyperbaric solution 3ml ,20-30 minutes after the observation of non-spinal anesthesia and the phenomenon of delayed eruption, and then 1200 units of collagen diluted in 2-4ml saline, slow injection, takes 10 minutes or more, and then needle injection, local dressing over. 5, the small joints of the film under way within the margin of vertebral body anteroposterior film, the film on the anteroposterior lumbar 5 - S1 spine clearance as the B point, the B point of the horizontal line and the small joints of the inner edge of the intersection point as A , BA, after the length of the midline of the body surface and the distance from the needle puncture, but also directly from the waist 5 - S1 open space adjacent to the midline after the 15-20mm needle point for the country. A point by 5 degrees tilt out the needle touched the bone is the small joints. Measuring the depth of needle into the skin back, then up to the original vertical depth of the needle, find the inner edge of the small joints and touch yellow ligament. The following way with the laminectomy outside the notch. 6, indications recognized standards at home and abroad, where one of the following conditions, consider the purposes of collagenase dissolved disc surgery: 1, unilateral low back pain, and significant nerve root compression symptoms. 2, in line with indications for surgical resection. 3, after 3 months of formal conservative therapy with no response. Collagenase dissolved in the choice of disc surgery indication, we must pay attention to the following questions. Because the mechanism of treatment is to intradiscal collagenase into the lesion or around protrusions, relying on decomposition of collagen fibers by collagenase to dissolve the pharmacological effects of collagen, the decrease or disappearance of prominence, alleviate or eliminate their nerve Organization of oppression, improve clinical symptoms. To be dissolved by body position changes seems to be indications. Collagenase treatment has calcified protrusion effects are poor, because only soluble collagen by collagenase, nucleus and annulus, no dissolution of calcium salt crystals. For the bony lumbar spinal stenosis, and inappropriate use of collagenase injection. Because the disc is dissolved in the collagen fibers, the disc height decreased, resulting in excessive duplication of small joints of the spine, nerve root channel narrowing, the original narrow further. Collagenase dissolved disc surgery indication is relatively narrow. For there is a second diagnosis (spinal stenosis, spondylolisthesis, etc.) of the patients were treated poorly. Only based on the patient's chief complaint and CT inspection report "bulging disc" disc will be the implementation of the collagenase solution in the treatment, patients with low back pain symptoms after treatment, but worse. Review of imaging data and clinical signs of inspection, realized due to multiple lumbar intervertebral disc degeneration and lumbar instability led to symptoms and signs caused, after the application of facet joint injections, and supported by management
Disc herniation patients were treatment measures. Some only give one piece CT window level and window width, so can not confirm whether there is calcification of the prominence or ossification. After the chemical treatment of intervertebral disc dissolution is poor, re-review the use of CT window level and window width of two observation found prominence has calcification. There can not be parallel scan lines, such as through the corresponding intervertebral space (L5 ~ S1 segment in common); or not cut to the lateral recess plane, etc., these are indications of selection caused a major cause of failure. 7, contraindications for these patients, surgery should be implemented cautiously dissolved collagenase discs: 1 allergy. 2, cauda equina syndrome,. 3, metabolic disease. 4 intervertebral disc inflammation or infection. 5, psychopath. 6, bone and low back pain by lumbar spinal stenosis. 7, non-discogenic low back pain are. 8, pregnant women and children under 14 years of age. 9, prominence divorced outside of lumbar spinal canal. 10, calcification or ossification of prominence who have been. Healthy self-test 1, head, neck, shoulder if there were heavy, pain, abnormal sensation, and tenderness associated with the corresponding points; 2, the neck to the shoulder and upper limb pain often radiation; 3, the neck, have a strong feeling li