lumbar disc herniation The onset of lumbar disc herniation is due to degeneration of the lumbar intervertebral disc (composed of the nucleus pulposus, annulus fibrosus, and cartilage endplate), along with partial or complete rupture of the annulus fibrosus, leading to the protrusion of the nucleus pulposus, which stimulates or compresses the nerve roots and cauda equina, resulting in a syndrome. This condition is also a common degenerative spinal disease in clinical practice. Its main symptoms include lower back pain, sciatica, numbness in the lower extremities, and cauda equina syndrome.

There are various classification methods for lumbar disc herniation based on the degree of protrusion and imaging characteristics, combined with treatment methods, the following classifications can be made:

Protrusion-type lumbar disc herniation

Partial rupture of the inner layer of the annulus fibrosus, but the outer layer remains intact. At this stage, the nucleus pulposus bulges into the spinal canal due to pressure, but the surface remains smooth. Most cases of this type can be relieved or cured with conservative treatment.

Extrusion-type lumbar disc herniation

Complete rupture of the annulus fibrosus, allowing the nucleus pulposus to protrude into the spinal canal, while the posterior longitudinal ligament remains intact. The decision to perform surgical treatment depends on the severity of the condition.

Sequestration-type lumbar disc herniation

The nucleus pulposus ruptures through the posterior longitudinal ligament and enters the spinal canal, but its base remains within the intervertebral space. The decision to perform surgical treatment depends on the severity of the condition.

Migrated-type lumbar disc herniation

The nucleus pulposus tissue penetrates through the annulus fibrosus and the posterior longitudinal ligament, completely protruding into the spinal canal and detaching from the original intervertebral disc. The decision to perform surgical treatment depends on the severity of the condition.

Other types of lumbar disc herniation

These include Schmorl's nodes and anterior bone protrusion. The former refers to the penetration of the nucleus pulposus through the fissure between the superior and inferior endplates of the vertebral body into the cancellous bone. The latter is when the nucleus pulposus protrudes in the direction of the anterior longitudinal ligament through the vascular channel between the vertebral endplate and the vertebral body, forming freely movable bone fragments at the anterior edge of the vertebral body. These two types do not present with neurological symptoms and do not require surgical treatment.

Intervertebral disc degeneration: With increasing age, the intervertebral disc gradually undergoes degeneration, with a gradual decrease in the water content of the nucleus pulposus and the loss of elasticity, as well as the appearance of fissures in the annulus fibrosus. On the basis of degeneration, accumulated strain and external forces can lead to disc rupture, causing the protrusion of the nucleus pulposus, annulus fibrosus, and even the endplate, resulting in compression of the nerves and the onset of symptoms.

Injury: Cumulative injury is the main cause of intervertebral disc degeneration. Repeated bending, twisting, and other movements are most likely to cause intervertebral disc injury.

Pregnancy: During pregnancy, the entire ligament is in a relaxed state, while the lumbar sacral region is subjected to greater stress than usual, increasing the risk of disc herniation.

Genetic factors: About 32% of patients under 20 years of age have a positive family history.

Abnormal lumbar vertebral development: Abnormal lumbar vertebral development causes abnormal stress on the lower lumbar vertebrae, thereby increasing the risk of disc damage.

Lower back pain

This is the most common symptom and is often the initial symptom. Most patients experience recurrent lower back pain before developing leg pain. Some patients experience lower back pain and leg pain simultaneously, while others only have leg pain without lower back pain. The lower back pain caused by lumbar disc herniation is due to the protruding intervertebral disc compressing the outer layer of the annulus fibrosus and ligaments, irritating the nerves within the spinal canal.

Sciatica

In most cases of lumbar disc herniation, the disc protrusion occurs at the L4-L5 and L5-S1 levels. The pain is gradual and radiating, starting from the buttocks and extending along the back of the thigh to the calf and dorsum of the foot. In an effort to alleviate the pain, some patients lean forward while walking, and when lying down, they assume a position with the hips and knees bent.

Numbness in the lower limbs

When the protruding lumbar disc irritates the sensory and tactile fibers, it leads to numbness in the areas of sensation distribution according to the nerve innervation.

Decreased muscle strength (weakness) in the lower limbs

Lumbar disc herniation causes damage to the nerve roots, leading to varying degrees of paralysis in the muscles they innervate. In mild cases, there is a weakening of muscle strength, while in severe cases, the muscles lose function. However, cases of limb paralysis due to lumbar disc herniation are relatively rare.

Cauda equina syndrome

Lumbar disc herniation can compress the cauda equina, leading to urinary and fecal dysfunction, as well as abnormal sensation in the saddle area. In acute cases, this serves as an indication for emergency surgery.

Intermittent claudication

This is a specific manifestation of lumbar spinal stenosis, characterized by the occurrence of lower back pain, radiating leg pain or numbness on the affected side as the distance increases. Symptoms can be alleviated by squatting or sitting, and after walking a certain distance, the symptoms reappear.

Due to individual differences, there is no absolute best, fastest, or most effective medication. In addition to commonly used over-the-counter drugs, the most suitable medication should be chosen in conjunction with a doctor's guidance, taking into account individual circumstances.

Nonsteroidal anti-inflammatory analgesics:

In cases of radicular pain due to spinal degeneration, primarily inflammatory pain, nonsteroidal anti-inflammatory analgesics should be considered, such as ibuprofen, diclofenac, meloxicam, and celecoxib.

Muscle relaxants:

For patients with muscle spasms, muscle relaxant medications such as chlorzoxazone, tizanidine, and baclofen can be used.

Dehydrating agents:

Dehydrating agents like mannitol can be used if there is suspected neural edema.

Glucocorticoids:

When there are no contraindications, short-term use of glucocorticoid medications can effectively alleviate inflammatory pain reactions.

Indications for surgical treatment of lumbar disc herniation include:

- Severe and recurrent lumbosacral pain persisting for more than three months with no response to non-surgical treatment, and the condition progressively worsens, significantly affecting work and daily life.

- Manifestations of significant nerve involvement, such as decreased muscle strength in the nerve distribution area, foot drop, etc.

- Cauda equina syndrome or dysfunction of the anal sphincter, requiring emergency surgery.

Contraindications for surgical treatment of lumbar disc herniation include:

- Not meeting the surgical indications, first occurrence, or short course of the disease without conservative treatment.

- Lumbar disc herniation combined with multiple fibrous tissue inflammation or rheumatic disease with unclear conditions.

- Clinical symptoms suspected of lumbar disc herniation but lacking typical radiological changes.

Common surgical procedures for lumbar disc herniation include:

- Endoscopic discectomy

- Simple laminotomy and discectomy

- Hemilaminectomy

- Full laminectomy

- Interbody fusion surgery

Encourage early return to moderate normal activities once symptoms improve. A comfortable lying position involves lying on the back with a pillow under each knee and head raised, or in a side-lying position with a pillow between the knees.

- Maintain good lifestyle habits to prevent the lower back and legs from getting cold and to avoid excessive fatigue.

- Diet: Proper diet with frequent small meals, including vegetables, fruits, and foods rich in calcium.

- Correct posture while standing or sitting to ensure even stress distribution on the spine.

- Exercise: Strengthen the lumbar muscles to increase spinal stability.

- Avoid or minimize bending at the waist, especially when lifting heavy objects.

- Be cautious with massage therapy, and seek treatment from reputable medical and rehabilitation facilities.

- Avoid relying solely on external remedies such as plasters for symptom relief.

Prevention focuses on reducing cumulative damage, such as avoiding excessive bending and stretching during exercise. Maintaining good lifestyle habits, including regular exercise and proper posture, is also meaningful for prevention.