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treatment for ruptured disc


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treatment for ruptured disc

Degenerative changes in lumbar intervertebral disc annulus fibrosus due to trauma or rupture, prolapse of the nucleus from the rupture, compression of lumbar nerve root or cauda equina, and the emergence of radioactive waist and legs and a series of nerve pain symptoms, known as lumbar disc protrusion (expansion) the disease or rupture of lumbar intervertebral disc disease. Lumbar mainly in the elderly and long term to maintain a fixed position of the populations, such as office staff, computer operators, accountants, typists, teachers, drivers, these people due to the long lack of physical exercise, physical fitness is relatively weak, and their lumba
r spine static long bear, "Office Block family," the crowd of the lumbar spine prone to disease. Then there a long time engaged in physical labor or long and severe cold and humid environment in the work of people are prone to spinal lesions. Lumbar disc herniation more common in young adults aged 20-40, accounting for 80% of the number of patients, significantly more than men, women, rural areas than cities. Occurred in women after pregnancy, low back pain is often sudden severe abnormalities, activity impairment, lumbar disc herniation are common in young people, particularly manual workers, multiple or prolonged sitting, no significant incidence of male and female difference. In addition to a small number of young people caused by the trauma, the overwhelming majority because people lack health awareness, not pay attention to rest, triggered by the body strain. In particular, some workers, drivers and copy the incorrect posture or sedentary, frequent neck and shoulder discomfort, back pain, leg pain, numbness and other symptoms, eventually leading to the occurrence of lumbar. What are the clinical manifestations of lumbar disc? (1) low back pain: the pain in leg before, also the same time. Lumbar or lumbosacral pain mainly in the next, the reason is mainly because of pain after the stimulation of the annulus outer disc and posterior longitudinal ligament of the vertebral nerve fibers in the sinus arising. Pain location deep, difficult to locate, usually dull pain, tingling or radioactive pain. (2) lower limb radiation pain: the lumbar intervertebral disc occurred in the lumbar sacral 1, 4,5 and 5 lumbar intervertebral space, the sciatic nerve was 1-3 from the lumbar and sacral nerve roots 4,5 Therefore, patients with multiple lumbar disc herniation has sciatica, and more start with the hip, gradually radiating to the posterolateral thigh, lateral leg, dorsal foot and lateral plantar and toe. Outstanding common cause of central bilateral sciatica. When coughing, sneezing, and urine and other intra-abdominal pressure when the transmission of power as increased lower extremity radiating pain increased. Leg pain emphasis on low back pain is one of the main signs of disc herniation. (3), numbness and paresthesia: lumbar disc, the nerve root can cause localized contact area involves sexual repression and oppression, the body of the nerve root compression caused by fibrous and vascular ischemia and hypoxia, so the dominant nerve root involvement regional pain, numbness and other abnormal feelings. 4,5 lumbar intervertebral disc can affect L5 nerve root and the emergence of thigh, lateral leg, dorsal foot numbness dorsal lateral and toe abnormalities. L5 S1 disc can affect the dorsal 4,5 toe paresthesias. If the disc herniation oppression or stimulate the paravertebral sympathetic fibers, can cause reflex contraction of lower extremity vascular wall of the lower extremities cold, cold, dorsal artery weakens and so on. (4) muscle paralysis: after lumbar disc protrusions longer of nerve root compression, nerve root ischemia and hypoxia can cause neurological degeneration and paralysis, muscle paralysis. 4,5 lumbar disc herniation, can cause paralysis caused by L5 nerve root anterior tibial muscles, peroneal muscles, extensor hallucis longus and extensor digitorum muscle paralysis. L5 S1 disc, the S1 nerve root palsy involved the emergence of calf triceps paralysis. (5) intermittent claudication: the disc herniation nerve root compression, nerve root caused by congestion, edema, inflammation and ischemia, when walking, the spinal canal obstruction of the vertebral venous plexus congestion, increased the degree of nerve root and congestive expansion of the spinal cord blood vessels, but also increased the emergence of nerve root compression and pain of intermittent claudication. (6) Spinal posture changes: lumbar disc after about 90% of patients with different degrees of functional scoliosis, convex to the majority of the affected side, a small number of convex to the healthy side, the main visual prominence and the relationship between nerve root. Scoliosis can nerve root relaxation, reduce pain. If the protrusion in the anterior lateral nerve roots, the spine is convex to the affected side; prominence inside the nerve roots, the spine is convex to the healthy side. Scoliosis is to reduce the prominence of nerve root compression in a protective compensatory measures. Common cause of lumbar disc herniation What? (1) disc degeneration: Under normal circumstances, the intervertebral disc are often oppressed by the weight, plus the waist and often the buckling, extension and other activities, more likely to cause vertebral disk larger Q extrusion and wear, especially under the waist of the disc, resulting in a series of degenerative changes. (2) the role of some people in their daily life and work, there are often long-waist improper force, excessive force, improper posture or body position and so on. For example, the staff handling the long-term bending lifting heavy objects, the driver seat and the top long-term strategy in the state. These long-term repeated minor damage caused by external forces. Excessive weight: engaged in heavy physical work and weight training over time often due to excessive load to act on the disc, increased the degree of degenerative diseases. (3) predisposing factors: ① a sudden load or flash waist: the waist of a sudden load increase, especially in fast bending, lateral bending or rotation, is the main reason for the formation of fibrous ring rupture. ② lumbar trauma: strong violence, not cause fracture and dislocation, there may have been prominent degeneration of the nucleus. In addition, inspection or spinal anesthesia for lumbar puncture may also be generated after the disc. ③ improper posture: get up, stand up and other daily life and some of the work, if the waist is in flexion, the sudden movement of rotation to give a plus, the easy to induce prominent nucleus. ④ abdominal pressure: abdominal pressure and the disc has a certain relationship, sometimes even in the severe coughing, sneezing, constipation, hard breath may also occur when the nucleus prominent. ⑤ catch cold by the wet: cold or wet can cause the small blood vessels, muscle cramps, increased pressure to disc, can also cause degeneration of intervertebral disc rupture. Completely cured after surgery of lumbar disc herniation can it? When the lumbar disc, the annulus, posterior longitudinal ligament and dura mater of the nerve fibers are stimulated, causing low back pain; prominence direct nerve root compression, would cause lower extremity radiating pain, if the protrusion huge pressure to the surface below cauda equina, there will be large, urinary dysfunction, incomplete paralysis of both lower extremities and other symptoms of lumbar disc surgery many ways, its main goal is to remove the overhang caused by mechanical pressure and chemical stimulation, to eliminate or alleviate the symptoms. Strictly speaking, surgical treatment and non-surgical treatment, just as symptomatic treatment rather than the so-called "cured." Neither the incidence of surgery can restore the previous state of the waist, it will not terminate the lumbar degenerative process. Therefore, patients should have adequate knowledge of surgical treatment. Topical drugs in the treatment of various bone and joint diseases (including lumbar spine disease), the plays an important role, mainly to play fast pain relief, elimination of inflammation, accelerate healing and getting a vivid effect on soft tissue injury, poor blood, inflammation The bone and joint and soft tissue disease effect is obvious, there are substantial therapeutic effect. But for disc herniation, lumbar facet joint dysfunction, lumbar hyperplasia can not play a substantive treatment because of disc herniation, lumbar facet joint dysfunction, lumbar hyperplasia and other diseases is there because of ectopic lumbar joints and its annex, pressure around the nerves, blood vessels, leading to soft tissue inflammation, pain, limited joint movement, limb numbness, muscle atrophy, therefore, to anti-inflammatory, pain, active topical preparations for the main function would not achieve a substantial therapeutic effect, only to the temporary elimination of inflammation, relieve pain, herniated disc can not be reset, osteophyte proliferation can not be eliminated, the solution is the only channel for the physical reset (surgery, traction, bone, osteophyte melting technique, etc.). Health insurance can play back the role of the entire bone, quick to ectopic lumbar intervertebral disc, lumbar facet joint reduction, lift the nerve, vascular compression, so some patients can reduce the day. Sustainable traction because of its home, so back to the nucleus to be satisfied that the consolidation of the hospital will not be short-term traction, nucleus reset, due to pressure of a patient's own standing has been pressed out, and repeatedly, but the phenomenon is difficult to recover. To be sure, topical drugs can not play a role in Orthopedics for the type of disease, treatment can not eradicate the purpose of play. Oral drugs in the treatment of various bone and joint diseases (including lumbar spine disease), the important role that they play a major pain, inflammation, accelerate healing and getting a vivid role, some drugs can also increase bone density, joint organization of the various play some role in maintenance. Thus, such drugs on a soft tissue injury, poor blood, inflammation of bone joints and soft tissue disease effect is obvious, there are substantial therapeutic effect on osteoporosis, aging joints, but for substantive treatment of intervertebral disc syndrome, lumbar facet joint dysfunction, lumbar hyperplasia can not play a substantive treatment because of disc herniation, lumbar facet joint dysfunction, lumbar hyperplasia and other diseases is there because of ectopic lumbar joints and accessories, peripheral nerve compression , blood vessels, leading to soft tissue inflammation, pain, limited joint movement, limb numbness, muscle atrophy, and thus, to inflammation and pain, the main function of active oral drugs will not achieve a substantial therapeutic effect, only the temporary elimination of inflammation to ease the pain, herniated disc can not be reset, osteophyte proliferation can not be eliminated, the solution is the only channel for the physical reset (surgery, traction, bone, osteophyte melting technique, etc.). Health insurance can play back the role of the entire bone, quick to ectopic lumbar intervertebral disc, lumbar facet joint reduction, lift the nerve, vascular compression, so some patients can reduce the day. Sustainable traction because of its home, so back to the nucleus to be satisfied that the consolidation of the hospital will not be short-term traction, nucleus reset, due to pressure of a patient's own standing has been pressed out, and repeatedly, but the phenomenon is difficult to recover. Of course, some can improve bone, getting a vivid, nutrition, drugs or nutrition class joint, and moderate exercise, can significantly improve the patient's bone quality, enhance patient's muscle strength, thus reducing disc herniation in patients with small joint function disorders, the possibility of bone hyperplasia; but once you suffer from above diseases, or physical means to lift reduction (surgery, traction, bone, osteophyte melting technique, etc.). Traction is the treatment of disc herniation, lumbar facet joint dysfunction, lumbar spine proliferation of conservative therapy such as core therapies; General Hospital, once diagnosed, were treated with traction therapy have suggested, but why many patients are poorly it? In fact, not a doctor right treatment choice, but the current limitations of the hospital traction device can not be solved: that is, through the hospital traction bed traction, will highlight the nucleus or translocation of the vertebrae reset, the patient must stand to go home in the reduction of the nucleus under its own gravity emerge again, just pull the vertebrae back to the original space with the oppression of the state, so again, so patients do not feel the effect! The only way to solve this problem is to have sustained enough traction time to reset the disc, opening the disc space of time sufficient to consolidate! Kangbao waist just to solve the above problem, the household-type characteristics, so that patients do not have to go to the hospital, at home that is sustainable traction to ensure the reduction of the nucleus, vertebrae sufficient time to heal and consolidate. In addition, the auxiliary support positioning, nano-magnet radiation, and allow the vertebrae, intervertebral discs, damaged nerves, blood vessels, muscles and other quick access to nutrition, treatment of the consolidation. How to protect our everyday life of the lumbar spine? Low back pain is lumbar strain injury by the accumulation of early signs of chronic low back pain were approximately 35% eventually develop lumbar disc herniation. Therefore, in daily life and work, how to protect our spine is very important. 1. Waist long withstand the stress overload is the main cause of chronic low back pain, therefore, such personnel shall strengthen the waist, usually the proper use and care. Note the correct posture at work the waist; attention to rest, work and rest to prevent fatigue; prevent the waist by negative factors such as trauma and cold stimuli; appropriate physical exercise, especially strengthening the lower back muscles. These measures can effectively prevent and reduce strain on lower back muscles and discs. 2. In addition, bending to move heavy objects, bending carrying a child, suddenly reversing the waist and bending under strong extension and other activities are likely to damage the muscles and the lumbar intervertebral disc. Therefore, if the move should be knee squat lifting heavy objects, move through the body so that shared in the leg muscles of gravity, reducing the burden on the waist; the same time, it should gradually increase the force to prevent the waist of a sudden force. Manual for those who rarely people should be especially attentive. 3. Already have back pain symptoms, the workload should be reduced, proper rest; low back pain, severe symptoms, frequent attacks who should be stopped, absolute rest, but it is best to stay in bed. 4. Should be avoided for a long time watching TV. In the small living room, not to put the TV too high, but their short bench sitting watching TV when the lower back kyphosis, head and neck to the back of neck and waist are unfavorable. Best to sit on the couch watching TV or on chairs at the waist also try to put a pad pillow, withstand the waist. The end of a day watching television, fatigue and soreness should be appropriate to the waist Buzhi Yu. 5. Sleep beds should choose a hard wooden bed, put Banchuang or other flexible harder Simmons bedding, sleep position to slightly lower limb flexion, lateral position as well.
Minimally invasive treatment of disc video
Dean of orthopedic experts Han Guangming, Suzhou Tongji you a comprehensive interpretation of lumbar disc herniation causes, typical symptoms, diagnosis, treatment and lumbar spine care. Tongji Hospital, Suzhou, the introduction of minimally invasive techniques first, the creation of comprehensive treatment of lumbar disc herniation system, the system includes conservative treatment, minimally invasive therapy, open surgical therapy, hotline :0512 -68551999.
This is the spine of lumbar disc simulates map, the red particles at the nucleus for the herniated disc.
What is a lumbar disc herniation?
Lumbar disc herniation, also called the nucleus pulposus protrusion, or rupture of lumbar intervertebral disc is a clinical disorder is more often one of the waist of the wind. The lumbar disc disease is due to the various parts, especially the nucleus, there are different degrees of degenerative changes, the role of external factors, fibrous ring of intervertebral disc rupture, rupture of the nucleus pulposus from protruding from the rear or at the spinal canal, lead to adjacent tissue, such as the spinal nerve root irritation or spinal cord subjected to oppression, resulting in lower back pain, the side of the lower limb or lower limb numbness, pain and a series of clinical symptoms.
What are common causes of disc?
(1) degenerative changes in lumbar intervertebral disc: In normal circumstances, the disc often oppressed by the weight, plus the waist and often the buckling, extension and other activities, more likely to cause greater compression of vertebral disc Q and wear, especially under lumbar intervertebral disc, resulting in a series of degenerative changes.
(2) external force some people in their daily life and work, there are often long-waist improper force, excessive force, improper posture or body position and so on. For example, the staff handling the long-term bending lifting heavy objects, the driver seat and the top long-term strategy in the state. These long-term repeated minor damage caused by external forces. Asked over time to act on the vertebral disc and increased the degree of degeneration.
(3) disc itself weaknesses anatomical factors
â‘  After the disc in the adult lack of blood circulation gradually. Repair capacity is also poor, especially in the degeneration occurs, the repair capacity also seems to have nothing.
â‘¡ the outer fibrous ring of vertebral Q weak after-hours, and then longitudinal ligament in the lumbar 5 and sacral 1 plane, the width of the significant decrease in the strengthening of the role of the annulus was significantly reduced.
(4) triggers
â‘  sudden load or flash back: a sudden increase in load the waist, especially in fast bending, lateral bending or rotation, is the main reason for the formation of fibrous ring rupture.
â‘¡ lumbar trauma: strong violence, not cause fracture and dislocation, there may have been prominent degeneration of the nucleus. In addition, inspection or spinal anesthesia for lumbar puncture may also be generated after the disc.
â‘¢ improper posture: get up, stand up and other daily life and some of the work, if the waist is in flexion, the sudden movement of rotation to give a plus, the easy to induce prominent nucleus.
â‘£ abdominal pressure: abdominal pressure and push the disc herniation have a certain relationship, sometimes even in the severe coughing, sneezing, constipation, hard breath may also occur when the nucleus prominent.
⑤ catch cold by the wet: cold or wet can cause the small blood vessels, muscle spasm, so that increased pressure to push discs may also cause disc degeneration and rupture between the push.
The typical symptoms of lumbar disc herniation
(A) low back pain, radiating pain and the side of the lower limbs are the main symptoms of the disease. Low back pain often occurs in the leg before, but also both simultaneously; most of them have a history of trauma, but also the absence of explicit incentives. Pain has the following characteristics:
1. Radiating pain along the sciatic nerve conduction, direct access to the lateral leg, dorsal foot or toes. Such as lumbar 3-4 highlight the gap, because the oppressed L4 nerve root, resulting in pain radiating to the front of the thigh.
2. All the action of increased cerebrospinal fluid pressure, such as coughing, sneezing, and bowel and so on, can aggravate back pain and radiating pain.
3. Activities, the pain intensified, after the break reduced. Bed position: the majority of patients with lateral position, and limb flexion; individual cases of severe pain in the various positions are only the hip flexor knees kneeling on the bed to relieve the symptoms. Combined lumbar spinal canal stenosis, often intermittent claudication.
(B) scoliosis: lumbar major curve in the next, when the more obvious flexion. Highlight the direction of bending depends on the relationship between nucleus and nerve roots: such as prominent at the front of the nerve roots, trunk usually to the risk of scoliosis.
(C) of the spinal activity limitation: nucleus pulposus protrusion, nerve root compression, tension in the psoas muscle was protective, can occur in unilateral or bilateral. The psoas muscle tension, physiological lumbar lordosis disappeared. Spinal flexion, extension activities restricted, flexion or extension can occur when the pain radiating to the side of the lower limbs.
(D) lumbar tenderness with radiating pain: herniated discs of the spinous process with limited ipsilateral tender points, and accompanied by pain radiating to the leg or foot.
Staging of lumbar disc herniation
1) to highlight the previous: The degeneration of nucleus pulposus and damage due to be tilting into pieces, or showed a scar-like connective tissue, thinning and degeneration of the annulus can be soft and have cracks.
2) to highlight the period: When the disc pressure increases, degenerative weakness in the nucleus or from ruptured annulus prominent, can have five types:
â‘  ring annulus bulging, swelling between the posterior margin of the adjacent vertebrae, annulus complete, do not cause clinical symptoms;
â‘¡ limitations bulging annulus, annulus bulge limitations, but the annulus complete, can produce clinical symptoms;
â‘¢ disc, highlighting the nucleus is bound by a thin fibrous ring, can produce severe clinical symptoms;
â‘£ disc prolapse, highlighting the nucleus through the complete breakdown of the fibrous ring, located under the posterior longitudinal ligament, the nucleus can be located in the nerve roots, bottom, or middle of the spinal canal at the front.
⑤ sequestered disc, nucleus pulposus through the complete rupture of the annulus and the posterior longitudinal ligament, divorced or even in intradural spinal subarachnoid, cauda equina or nerve root compression.
3) to highlight the advanced: disc herniation fibrosis or calcification. Intervertebral disc degeneration, anular shrinkage, disc space narrowing, vertebral bone sclerosis, osteophyte formation. Nerve root damage, long-term occurrence of nerve root compression can lead to adhesion, degeneration and atrophy. Yellow ligament hypertrophy, secondary to lesions that can lead to spinal stenosis. Facet degeneration and hyperplasia, due to disc space narrowing, facet compensatory load increases, arthritis can occur, proliferation and other changes. Secondary spinal stenosis, these changes can occur because of acquired spinal stenosis.
Classification of lumbar disc herniation
Lumbar disc herniation of nucleus pulposus according to a prominent position, extent, direction, degeneration and the relationship between nerve root and different imaging studies, a variety of typing methods, has no uniform standard. Reported a variety of type, multi-purpose and researchers about the research, and some will be divided into a complete model of lumbar disc herniation, subperiosteal fracture type and type of spinal fracture, and some are divided into succulent type, transitional type and mature, and some are divided into reversible and irreversible type, and some are divided into convex type, highlight the type and isolated type. Control of lumbar disc herniation type, the choice of treatment is essential, especially in non-surgical treatment, the correct application type, can improve the therapeutic effect, to prevent accidental injury. This chapter describes several treatment and surgery to accompany the sub-type.
Pathological type
Although a variety of lumbar disc herniation typing method, but most of the pathological type, based on this type can be divided into degenerative (degeneration), bulging type (bulging), highlight the type (protrusion), prolapse of the posterior longitudinal ligament following type (extrusionsubligamention), prolapse after posterior longitudinal ligament type (extrusiontransligamention) and free type (sequestered). Type for the end of the first three ruptured (contained), accounting for 77.4%, after the three types is ruptured (ruptured), accounting for about 37%. Based on the above classification method, the first four types of non-surgical treatment to achieve a satisfactory effect, after the surgical treatment of type II should be main focus, with the weight of traction and rotation reduction method, to prevent the increasing prominence or worse.
Location type
According to projections and spinal position (cross section) is divided into central (medial), after the lateral (posterolateral), the type of intervertebral foramen (foraminal) or said lateral and foraminal shape (extraforaminal) also known as extreme lateral (Figure 4-2). Before both sides of the more common, accounting for about 85%, after the two types of rare, and mainly in the waist and the waist 3 to 4 4 to 5 level. â…¢ degree of central type and classification, highlighting the central grade â… : to highlight the center but to the side of the main stretch is over the center line 2mm; outstanding degree of bone â…¡: to highlight the center but with the side of the main stretch is over the center line 4mm; Central â…¢ degree of prominence: highlight the center, extending to both sides.
Under the nerve root and herniated into the relationship between shoulder type, shoulder type before, armpit type. Shoulder-type: the prominence of the shoulder in the lateral nerve root; shoulder before the type: the prominence in the ventral nerve root, the nerve root to the rear roof; armpit type: overhang between the nerve root in the dural sac and nerve root compression, up tortuous deformation.
Form type
Into convex type, burst type and free type.
Convex type: internal annulus rupture, the nucleus due to the pressure of the outer bulge, often has a hemispherical, isolated posterolateral disc bulge at the Home nerve root in the bottom of the front or outside (about 30%). Pro should show: the young, slow onset, early onset of low back pain is more important than leg pain, nerve root irritation is obvious, such as skin allergies, but the muscle atrophy was not obvious. X-ray film may show disc space after the former narrow width.
Rupture: anular rupture or almost full rupture (67%), has fibrosis induced by nucleus pulposus or annulus fibrosus broken part of the shift back into the spinal cartilage, highlighting the rugged surface of the block, only film coverage, highlighting the range of generally more extensive raised from the type, and nerve roots may have adhesions. Two articles can be severe nerve root compression or cauda equina compression syndrome produced, the main body of lumbar kyphosis. Dependence of the X ray film edge hardening. Angiography showed a large individual side or front of the oppression, I highlight the case of the central type.
Free type: rare, the prominence has left the mouth of the rupture moved to highlight the spinal canal, and even breaking into the subdural cavity, may compress the dural sac and nerve root stimulation, similar clinical signs and rupture, nerve root pain, light, However, severe symptoms of cauda equina compression. Non-surgical method to uplift type smell the best, followed by rupture, travel rate type should be surgery.
General classification. Jiang put forward in 1985, Chuang bit discogenic low back pain three sub-types, namely, elastic type, failure type and proliferative degenerative stenosis.
Stretch type: young common. Often accompanied by a fall, flutter, flash, twisted, and other injury history. Incidence of acute low back pain was continuous, radicular symptoms. From the pathological point of view, this type of disc tissue elasticity is better, the outer annulus complete, smooth protrusion. X ray showed normal vertebral height gap, CT show was a prominent hemispherical edge of the neat blocks of shadow, facet joints, ligamentum flavum no abnormal changes.
Degenerative instability type: Middle-aged common. Disease characteristics: on the basis of chronic low back pain radiating pain lower limbs suddenly appeared. Flash slight waist, twisting as it could be an incentive. Often has been a marked disc degeneration and facet joint instability occur under the circumstances, with the funding situation changes or bed rest, relieve symptoms, but also turn a double string of lower limb pain. X ray findings showed disc space narrowing of the affected area, the edge of intervertebral cartilage appears sclerosis, vertebral and other signs around the edge of the shift. CT showed increased density of disc tissue, back prominent, or irregular blocks of video highlights, yellow ligament hypertrophy, facet hyperplasia.
Hyperplastic stenosis: more common in old age, the above two types of adverse outcome, or the disc and facet joint degeneration caused by spinal stenosis resulting late. Clinical features with previous history of overload or chronic fatigue, persistent low back pain, intermittent claudication, lumbar lordosis change than fixed, the limitations of this type in order to highlight the disc, such as pathological calcification. X-ray, CT has the typical signs of spinal stenosis or lateral recess stenosis.
Elastic-type non-surgical treatment is good, especially the traction, traction can increase the disc space, reducing intradiscal pressure, increase the compressive stress after the longitudinal ligament, prompting the nucleus also satisfied to help annulus repair, change and relationship between the location of nerve roots to alleviate or relieve symptoms of nerve root compression. Degenerative instability traction and pull the instability of the vertebral rotation rectified to correct the small difference between the half-dislocation. Traction and proliferation of narrow spin a release pull adhesion, joints and stretch muscles active role, but the effects are not satisfied, this type of longer duration and more for the elderly or persons, traction and spin should be careful not to pull too hard, so as to avoid accidental injury .
Diagnosis of lumbar disc herniation
Current clinical diagnosis of disc herniation imaging, a lumbar CT films, MRI and spinal angiography and other special.
(1) CT slice: intervertebral disc deformation or partial posterior margin prominent film; dura and fat shift, the plane of the ruptured disc, both sides of the bright areas comparing asymmetry; dura mater and the gap in the soft tissue density; dural sac deformation, appears oval, crescent-shaped pressure trace shadow; nerve root compression shift; nucleus calcification; Spinal vacuum phenomenon.
(2) magnetic resonance imaging (MRI) imaging: to highlight the nucleus clearly shows the shape (flat, circular, oval or irregular shape). In the sagittal images, the nucleus can be seen with prominent dural and fat boundaries clear, prominent part of the nucleus and the nucleus is not prominent part of the narrow neck between the connected.
Differential Diagnosis
1. Pelvic outlet syndrome. Pelvic outlet syndrome is when the sciatic nerve was stimulated by the export or pelvic pressure symptoms produced by group, the clinical manifestations of sciatic nerve irritation, starting at the hip pain along the sciatic nerve of radioactive walking and the movement associated with the 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. 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.
3. 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.
4. Gluteal muscle 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.
5. 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.
6. Sacroiliac joint strain. Clinical manifestations of persistent local pain, not weight bearing activities increase, turning difficult.
Treatment of lumbar disc herniation
Spinal health concerns, Suzhou Tongji Hospital, the first introduction of minimally invasive techniques in the province, the creation of comprehensive treatment of lumbar disc herniation system, the system includes conservative treatment, minimally invasive therapy, open surgical therapy. Lumbar disc herniation achieve systematic, standardized treatment. The creation and success of the treatment system fully operational, making Suzhou Tongji Hospital, a southern region and province-wide treatment of lumbar disc herniation of professional medical organizations. One of minimally invasive lumbar herniation treatment initiative, Tongji Hospital of Suzhou, the treatment of lumbar disc herniation treatment to fill the field has been blank, but also as a bridge, is wandering in the middle of conservative treatment and surgical treatment of patients found the recovery hope.
In order to carry out a comprehensive minimally invasive treatment of lumbar disc herniation, Tongji Hospital, the first disc cut from abroad smoke, mirrors and other items posterior disc of advanced minimally invasive techniques, minimally invasive treatment of the formation of a sound system of medical research over a long period , and clinical practice, found that minimally invasive treatment of lumbar disc herniation with less trauma and less complications, quicker recovery, safe, cost less to advantage. Lumbar disc herniation is one of many the best treatment.
Disc in Tongji Hospital Division, you do not have to worry about for the treatment, most comprehensive treatment system, rich treatment, complete treatment technology professional, personalized treatment options for patients with a huge selection, therefore, is insiders affectionately call "disc supermarket."
If you or your family suffering from back pain, numbness of the spine illnesses, what you hesitate, up to Suzhou Tongji Hospital, rehabilitation center, right disc, where the pain is not beating, not a high available afraid of the surgery; bone experts here will give you specify the appropriate treatment program; how to treat here, the biggest choice you have; here, Suzhou Tongji Hospital, you do not have to worry about finding the appropriate treatment.
Nucleus of ozone oxidation technique
Nucleus of ozone oxidation technique using strong oxidants, but also has good anti-inflammatory analgesic, and dissolved the role of the nucleus. The ozone gas into the nucleus through the fine needle aspiration, the nucleus dehydration, shrinkage, so that the disc decreases, reducing the role of the nerve root to achieve the purpose of cure.
Posterior discectomy Mirror
Mirror posterior discectomy: endoscope inserted through a small incision, clearly identified in the microscope, the organizational structure, accurate removal of nucleus pulposus that has the quick recovery of the advantages of tens of thousands of cases by clinical observation The total effective rate of 98% or more.
Editors:
Video: orthopedic specialist comprehensive analysis of the prevention and treatment of lumbar disc
Video: Suzhou, the first case of successful minimally invasive discectomy
Tongji Hospital of Suzhou disc introduction of international advanced interventional therapy, the use of physical effects, such as percutaneous radiofrequency nucleus, laser disc decompression; chemical reaction chemical dissolution of nucleus pulposus the collagenase technique, a variety of minimally invasive therapy in the treatment of intervertebral disc between prominent conservative and surgical, build a bridge, so that more complete and effective treatment of disc herniation. Read more
Tongji Hospital of Suzhou disc Hotline :0512 -68,551,999
Address: 36 West South Central, Suzhou
Care of patients with lumbar disc herniation
Sleep position
Of sleep can be divided into the supine position, lateral and prone position in three ways. Sit, as long as bedding appropriate to maintain the natural extension of the limbs, spinal curvature change little. Generally do not have too much stress on the left side or right lateral position, because people sleep more comfortable position to obtain the total to keep turning over, about 20-45 times a night. Pressure on the chest prone position, lumbar lordosis increases, easy to produce discomfort.
So, generally supine and lateral position is appropriate. Qualified patients, the supine position should be in the lower limbs, a soft pillow under the pad so that hips and knees bend, relax muscles, reduce disc pressure, reducing the tendency of intervertebral disc protrusion after, but also reduce the hip and lumbar sciatic nerve tension, so effective in preventing lumbar disc protrusion (expansion) a recurrence of disease, lumbar disc protrusion (expansion) from patients with the best position.
Should choose what kind of bed?
Normal life of about 1 / 3 of the time is spent in bed, many different types of beds, the beds too soft in the human body can be formed under the weight of oppression among the low, the high sides of the form, it is likely to cause lower back muscle tension increased, the course of time have resulted in local muscle, ligament balance disorders, a direct impact on the physiological lumbar curve, the disc were Shouli Bu.
Therefore, treatment and prevention of lumbar disc protrusion (expansion) a disease point of view, more appropriate selection of wooden beds.
But also enables simple applications have slightly curved spine, in the wet areas caused by poor ventilation pads were rotten before they are easy, so in general should be used to pave the way too soft bedding appropriate to a large extent, Wei Chi in order to balance the lumbar spine.
In addition, heated kang cold regions of northern China, but also with wooden bed has a similar advantage, but also to keep warm by heating, resulting in hyperthermia effect, is conducive to relax spastic muscles, relieve pain.
How to get out of bed in patients with bed rest?
Lumbar disc protrusion (expansion) a period of bed rest in patients, but also there are still large, urine, etc. need to get out of bed, how to get out of bed to avoid excessive lumbar activities and reduce waist burden? Get out of bed in patients with supine position, the first body to the contralateral side carefully, that is unaffected in the next, on both sides to take a half knee flexion, with the top hand up against the bed board at the same time, below the elbow with the half-bent The upper branch, the fulcrum to force the two, the patient will sit more easily and then stays in bed board by hand, with arm strength to make the body out of bed, while making the semi-flexion of hip and knee move the bed, and then support such as support with a cane to stand.
By the above method can get a whole body movement, thus reducing the waist flexion, lateral bending, tilt and other movements, without causing back pain or discomfort.
If a patient is difficult to separate out of bed, can help families get out of bed the same way.
Correct posture
Should be the upper body straight, abdomen, lower jaw slightly closed, the two legs close together. If possible, the best in the feet Xiadian a footstool or footrest, knees slightly higher than the hip. If sitting in the back of the chair, should be the basis of the above positions close as possible and rely on the back of a chair back, so not too lumbosacral muscle fatigue. Should also look after the sedentary activities, lower limb muscle relaxation.
In addition, the lumbar disc protrusion (expansion) should not take the patients out of 20cm below the low stool, you should take a chair back, as it can take part of the body weight relative to the lower back in a relaxed state and reduce back strain injuries opportunities.
What line of intercourse
Lumbar disc herniation and sexual function has little to do, will not be affected in the spinal cord nerve center of the relevant activities, it will not be oppressive dominant activity on the peripheral nerve, so to maintain good sexual function of patients.
However, in severe lumbar disc herniation, the activities will be limited waist, legs of the lifting action will be limited, sexual life, in particular to take the upper body position, sex and violent actions need to be more extensive action to help the waist, This will be difficult, and will add to the symptoms of low back pain.
Sexual health points:
â’ˆ moderate to severe lumbar disc herniation, symptoms, it is desirable to stop a stage of life, such as the strong desire of life, the patients should take the next bit of sexual intercourse position, so you can minimize the waist, sudden and strong chance of rotating bending .
â’‰ mild patients, sex is best sex position also used the next bit, if sexual intercourse with the upper position, then the action should pay attention to safe sex and rolls, not too intense, do not place a strong rotation and bending at the waist.
â’Š patients with this disease, before and after each sex, the waist should be appropriate massage movement, his hand up and down quickly in the waist on both sides for 1-2 minutes massage can alleviate the aggravated sexual life because of low back pain symptoms.
â’‹ If surgical treatment and postoperative cast immobilization were not used after 2 weeks to get up to walk, but the resumption of sexual activity at least 2-3 months later, if those who cast immobilization after surgery for a fixed time of 4 months, again 2-3 months after removal of plaster to resume sexual intercourse.
How to arrange food?
Lumbar disc protrusion (expansion) a reduction in sick patients because a certain activity, so the dietary intake should be appropriately reduced, especially in the acute phase of bedridden patients, in addition to reduced activity, the digestion also decreased slow gastric motility, it should be noted that reasonable arrangements for food, eat more vegetables, fruits and legumes, meat and high fat foods try to eat, because of its easy to cause dry stool, hard stool can lead to exacerbations.
Should Eat small meals often to eat 4-5 times a day. If a history of cough, to eat or not eat chili and other spicy food, so as to avoid leaving low back pain cough symptoms. In addition, the lumbar disc protrusion (expansion) patients out of any tobacco, alcohol addiction quit in time to facilitate a speedy recovery.
Note
(1) and symptoms of acute exacerbation of bed rest immediately to prevent ambulation, to reduce the prominence of nerve root irritation. Banchuang best for hard beds, bed thickness, softness and hardness, the bed height should be slightly lower, it is best just to make patients sit up, the feet can touch the ground. At the same time to avoid the purposes of acting on the lumbar vertebral bone and joint approach to take.
(2) symptom remission should be taken to minimize stimulation, avoid being affec
ted by cold and wet, avoid fatigue and lower back injuries.
Outstanding experts recommend:
Han Guangming, deputy chief physician
Han Guangming (Orthopaedics): Suzhou Tongji a comprehensive interpretation of lumbar disc experts. Specializes in orthopedic diagnosis and treatment of difficult cases. 96 in the southern regions of the first posterior cervical disc mirror discectomy, fusion, self-locking titanium plate fixation. Third Prize of provincial scientific and technological progress, was 96 years of meritorious service by the honorary title of Changzhou City.
In recent years, created a "disc supermarket", the first host system to carry out a disc herniation treatment system (a conservative, minimally invasive, surgery, etc.), for the majority of disc disease pain relief, with impressive results, has a high reputation. Engaged in this profession, the independent completion of more than 4,000 cases of disc surgery has not occurred in medical errors and medical malpractice.
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