protrusion of the lumbar intervertebral disc

Please: patients with low back pain, lower limb pain, or lumbar disc herniation should browse first, and then ask related questions:

If you have leg pain or low back pain, especially pain and numbness below the knee joint, it is best to do the following related examinations: X-ray film of lumbar spine in anteroposterior position, flexion and extension position and lumbar MRI.

Please also describe in detail:

1: Pain site: Do you have low back pain and leg pain, or both?

Key points: If you have leg pain, please describe the painful parts in detail (hip joint, inner thigh, outer thigh, around knee joint, below knee joint, instep, sole, etc.). ).

2. The nature of pain (low back pain and leg pain are discussed separately): Does pain affect sleep? Will it wake up with pain? Is it relieved after the rest? Does the pain always hurt, or does it hurt intermittently? Does it hurt when you bend over or stretch? Standing for a long time, sitting for a long time, will it hurt to lie down for a long time? Where does it hurt?

3. What factors can lead to the aggravation of pain? What factors can relieve pain?

4: Is there intermittent claudication? (that is, pain or numbness in the lower limbs (below the knee joint) occurs after walking for a certain distance, but it is relieved after sitting or bending for 3- 10 minutes, but the pain symptoms will appear again after walking. )

5. Are there any symptoms of weakness: I feel weak when walking, my legs are heavy, I feel stiff, and I have a hard time walking? Did you fall because of weakness in your lower limbs?

6. Is there numbness in the soles of your feet and the feeling of stepping on cotton?

If it appears:

1: If the lower limbs are weak or stiff, or the soles of the feet feel like stepping on cotton, it may be cervical spondylosis; If the hand feels numb, it can be further clarified.

2. If you feel pain at night (that is, you wake up with pain), or you feel pain at rest (even at rest, please pay attention to the pain after adjusting your position), it means that there may be spinal tumor, spinal tuberculosis or infection, or compression fracture caused by osteoporosis, or something else. Such patients need attention and detailed further examination. It is recommended to do MRI and CT of lumbar spine and anterolateral lumbar position.

3. If it is only low back pain, the rest is different. Pain after exercise: it may be lumbar spondylolisthesis, osteoporosis, or sacroiliitis;

4. If low back pain is accompanied by abdominal or stomach pain, the location of low back pain is not very clear: it may be visceral disease.

5. If you have low back pain, stand for a long time, sit or lie down for a long time, the pain on the outside or inside of the thigh: it may be discogenic pain or disc herniation. If it hurts when bending over, and the pain is affected by the weather and climate: it may be a small joint pain.

6. If there is only leg pain, but the pain is in the thigh: it may be discogenic pain or disc herniation.

7. If it is only leg pain, the pain is around the knee joint: it may be an intra-articular disease or a hip joint disease.

8. If there is only leg pain, but the pain is below the knee joint: it is most likely a lumbar disc herniation, spinal canal stenosis, or meniscus injury.

9. If you have lumbago and leg pain, analyze it according to lumbago and leg pain, otherwise it will be more complicated and difficult to simplify the discussion.

If it is lumbar disc herniation, there are two absolute surgical indications: 1, cauda equina syndrome, that is, numbness of the skin behind the buttocks, hypoesthesia, or defecation dysfunction (constipation or incontinence); 2, single nerve root paralysis (that is, thumb dorsiflexion, flexion disorder, muscle weakness or muscle atrophy); These two points are absolute surgical evidence.

Other relative surgical indications: 1, severe pain seriously affects life, and conservative treatment is ineffective; 2. Huge disc herniation; 3, conservative treatment for 6 months, ineffective pain affects life.

Treatment:

For severe leg pain (pain below the knee joint, that is, nerve root symptoms): dexamethasone 5mg qd ivgtt for 3 days; In addition, 20% mannitol was added.

250ml bid ivgtt, applied for 3-5 days, renal function was examined before use and after use. Only normal renal function can be used. If the above treatment fails, or the pain still affects life, surgery is recommended. (Provided that the diagnosis of lumbar disc herniation is clear)

If conservative treatment is adopted, the best way is to combine work and rest, that is, to stay in bed strictly for 2-4 weeks (do not carry heavy loads when defecating), and take celebrex (patients with hypertensive heart disease should take Fenbid instead)+sodium chloride+mecobalamin.

If there is no improvement after 3 -6 months of treatment, surgery is recommended. (Lumbar disc herniation, it is recommended to remove it; If it is discogenic pain, fusion or artificial intervertebral disc is recommended)

Severe low back pain: If it is sudden small joint pain, it is recommended to do local blocking treatment. If it is clear, it is suggested to treat it according to the characteristics of related diseases.

West China Hospital Orthopedic Spinal Surgery Kong Qingquan West China Hospital Orthopedic Spinal Surgery Kong Qingquan

(Dr. Kong Qingquan solemnly reminds me that because I can't see the patient face to face, I can't fully understand the condition. The above suggestions are for reference only. Please go to the hospital for specific diagnosis and treatment under the guidance of a doctor! )

Huaxi Hospital Kong Qingquan/