What is a Prolapsed Disc?

More common in young adults, often caused by chronic injuries, acute trauma can aggravate symptoms, mainly compression symptoms of nerve roots or spinal cord, manifested as chronic low back pain and radiation to the lower limbs, sometimes paraspinal and lower limb muscle spasms and even muscle atrophy , Restricted mobility, positive nerve traction test, etc.

Disc herniation

Intervertebral disc prolapse refers to a pathological condition caused by the nucleus pulposus and some fibrous rings of the intervertebral disc protruding to the surrounding tissues and compressing the corresponding spinal cord or spinal nerve root. It is related to intervertebral disc degeneration, injury and other factors. Lumbar 4/5 and lumbar 5 / 1 are the most common sites of disc herniation, followed by the cervical spine. There are three types of disc herniation: Central type refers to those who are located in the midline; Lateral type refers to those who are located inside the spinal canal on both sides of the midline; Lateral type: refers to those where the protruding disc is located outside the root canal, this type of spinal nerve Root compression symptoms are severe.

Clinical manifestations of disc herniation

More common in young adults, often caused by chronic injuries, acute trauma can aggravate symptoms, mainly compression symptoms of nerve roots or spinal cord, manifested as chronic low back pain and radiation to the lower limbs, sometimes paraspinal and lower limb muscle spasms and even muscle atrophy , Restricted mobility, positive nerve traction test, etc.

Intervertebral disc prolapse

X X-ray plain disc herniation

Indirect signs can be seen in lateral radiographs, such as narrow intervertebral space, which can be symmetrical or asymmetric. The wide side of the uneven gap is mostly the side of the disc herniation. For example, the posterior process of the intervertebral disc is mostly anterior narrow and wide. Overgrowth; abnormal spine curvature, etc.

Intervertebral disc prolapse

A typical disc herniation is a filling defect in the nerve root sleeve or a shortened root sleeve. The edema of the nerve root is compressed and thickened, making the root sleeve funnel-shaped, the dural sac is compressed and deformed, and the dural sac on the lateral osteosynthesis shows an arc-shaped disc impression at the level of the intervertebral space, and an impression at the lumbar Depth greater than 2mm is suspicious, and greater than 4mm has certain value. Prolapse of a large disc can cause obstruction of the medullary cavity. Compression of the cauda equina nerve in the dural sac is convergent and distorted. The above performance is obvious in the hyperextension position, the degree is increased, and the degree is reduced in the hyperflexion position.

CT CT findings of disc herniation

The posterior edge of the normal lumbar intervertebral disc does not exceed the posterior edge of the vertebral bony endplate, and the middle part is slightly concave and kidney-shaped. Intervertebral disc prolapse appears as a curved soft tissue shadow that locally protrudes from the posterior edge of the vertebral body. It is usually connected to the intervertebral disc and is more dense, with free epidural nucleus pulposus. The nucleus pulposus is above or below the level of the intervertebral disc, and its density is lower than that of the vertebra but higher than the dura mater and paravertebral soft tissue. The protruding disc can be calcified.

The epidural fat is compressed, displaced, or even disappeared, and the anterior edge or side of the subdural space is deformed by compression.

The intervertebral discs protruding laterally and rearward can shorten the anterior and posterior diameters of the lateral crypts, compressing the corresponding spinal nerve roots to shift them backward; the spinal nerve roots can also be thickened by edema. CT scan after spinal canal iodine contrast can help to show the changes of spinal nerve root sheath and dura mater.

Bone sclerosis in the back of the vertebral body and sometimes the upper and lower edges of adjacent vertebral bodies can be seen Schmorl nodules.

MR MRI findings of disc herniation

The prolapsed intervertebral disc is a slightly higher signal on the T1 weighted image than the subarachnoid space, and the disc signal on the T2 weighted image is reduced.

No matter what type of prolapse, compression of epidural and intervertebral foramen (high signal), nerve root, dural sac and epidural vein displacement can be clearly displayed, and the exudate generally remains connected to the disc.

After the enhancement, the scar after disc surgery can be distinguished from relapsed disc herniation.

Differential diagnosis of disc herniation

If the large lumbar disc herniation is not typical, it should be distinguished from tumors in the spinal canal. The density of the tumor is not as high as that of the intervertebral disc. The tumor is strengthened during enhanced scanning, while the disc herniation is not enhanced.

Factors of lumbar disc herniation induced by disc herniation

The basic factors that constitute lumbar disc herniation (bulging) are degenerative changes of the disc, and the factors that induce lumbar disc herniation (bulging) can be roughly divided into the following categories:

Traumatic disc herniation

Acute injuries, such as sprains of the lumbar spine, do not directly cause lumbar disc herniation (bulging). However, without the protection of the lower back muscles, it is easy to cause a disc herniation.

Excessive disc bearing prolapse

Engaging in heavy physical labor and weightlifting often results in early degeneration of the disc due to excessive load. With a spinal load of 100 kg, the normal intervertebral disc space narrows by 1.0 mm and bulges laterally by 0.5 mm. When the intervertebral disc degenerates, with the same weight, the intervertebral space narrows by 1.5 to 2 mm and bulges 1 mm laterally.

Prolapse of intervertebral disc

Drivers of cars and tractors have been sitting and turbulent for a long time during work. It was determined that when the driver stepped on the clutch, his disc pressure doubled. Such a long-term repeated increase in disc pressure can accelerate the degeneration or protrusion of the disc.

Impact of Poor Intervertebral Disc Prolapse

As people complete various tasks, they need to constantly change various positions, including sitting, standing, lying, and inevitable non-physiological postures. Poor postures often induce the occurrence of lumbar disc herniation (bulging).

Deformed spine deformity

In patients with congenital and secondary spinal deformities, the pressure on different parts of the annulus fibrosis varies, and often there is twisting, which is likely to accelerate the degeneration of the disc.

Intervertebral disc herniation

1 Intervertebral disc prolapse 1) Early stage of protrusion

At this stage, the nucleus pulposus can turn into pieces or scar-like connective tissue due to degeneration and injury. The degenerate fibrous ring can become thin and soft, resulting in fissures.

2 Disc herniation 2) Prominence

When the disc is subjected to increased pressure, the degenerated nucleus pulposus can protrude from the weak or ruptured fibrous annulus. There are five types:

The fibrous ring bulges in a ring shape, which bulges between the posterior edges of adjacent vertebrae, and the fibrous ring is intact, which may not cause clinical symptoms;

The localized bulging of the fibrous ring and the localized bulging of the fibrous ring, but the fibrous ring is intact, can produce clinical symptoms;

herniated disc, the prominent nucleus pulposus is constrained by a thin fiber ring, which can produce severe clinical symptoms;

Prolapse of the intervertebral disc, the prominent nucleus pulposus passes through the completely ruptured fibrous ring and is located below the posterior longitudinal ligament. The nucleus pulposus can be located above and below the nerve root, or directly in the middle of the spinal canal.

Free intervertebral disc, the nucleus pulposus passes through the completely ruptured fibrous annulus and posterior longitudinal ligament, free in the spinal canal and even in the subdural space of the epidural, compressing the cauda equina nerve or nerve root.

3 Intervertebral disc herniation

Intervertebral disc protrusions are fibrotic or calcified. Intervertebral disc degeneration, shrinkage of the annulus fibrosus, narrowing of the intervertebral space, sclerosis of the vertebral body, formation of osteophytes. Nerve root damage, long-term compression can lead to nerve root adhesion, degeneration and atrophy. Hypertrophy of the ligamentum flavum is a secondary lesion that can lead to spinal stenosis. Intervertebral joint degeneration and hyperplasia. As the intervertebral space becomes narrower, the intervertebral joints have an increased compensatory load, and arthritis and hyperplasia can occur. Secondary spinal stenosis, acquired spinal stenosis can occur due to the above changes.

Signs of disc herniation

When the lumbar intervertebral disc is protruded, the physiological curve of the lumbar spine decreases or disappears. If lumbar spinal stenosis is combined, there may be kyphosis.

Sacral scoliosis This is because the lumbar vertebra is convex toward the affected side, which makes the affected side's fibrous ring tense and part of the fibrous ring still accepted, so as to reduce the pressure on the nerve root of the intervertebral disc. In addition, the scoliosis of the lumbar spine is still affected by the iliac spine.

Patients with severe gait symptoms when suffering from lumbar disc herniation may have strict posture, lean forward or lameness when walking.

tenderness point. With tenderness of lumbar intervertebral disc, the tenderness point is mainly located next to the spinous process. 1.50-3.00 cm from the midline. The deep tissues here are the facet joint capsule, the yellow ligament, and the intervertebral foramen. The lumbar disc herniation (bulging) is due to the tenderness. The nerve root is often squeezed between the protrusion and the articular process and the yellow ligament. tenderness. In the case of tenderness, radiating pain in the lower limbs along the nerve root may occur, and the pain area is consistent with the plane dominated by the nerve root. Tenderness can also occur between spinous processes and spinous processes_L, but the main pain is palatal pain. In addition, the third lumbar vertebra process is often touched clinically as shown in the figure with tenderness.

Limited waist movement. When suffering from lumbar disc herniation, the lumbar disc herniation (bulging) causes the nucleus pulposus to protrude backward from the ruptured fibrous ring, aggravating the stimulation and compression of nerve roots, and the symptoms worsen; Those who appear or protrude, because of the tension of the posterior longitudinal ligament and the widening of the posterior intervertebral space, promote the nucleus pulposus to move forward, reducing the pressure on the posterior nerve root, resulting in reduced symptoms. When the waist moves toward the healthy side, the pain is reduced, and when the waist moves toward the affected side, the pain is increased.

Atrophy of lower limb muscles. In lumbar disc herniation (bulging), the muscles dominated by long-term affected nerves may have varying degrees of muscle atrophy. A small number of severe patients may lose the ability to extend the ankle or thumb.

Nerve dysfunction with lumbar disc herniation

(L) Sensory nerve disorders: mainly manifested as numbness, pain sensitivity, and decreased sensation. Distributed by the innervation of the affected nerve roots.

Motor neurological disorder: A decrease in motor strength is a more reliable sign. However, the muscular nerve is dominated by multiple nerve roots, so the weakening of muscle strength is not obvious.

(3) Reflex dysfunction: In the early stage of nerve root compression, lumbar intervertebral disc herniation (bulging) may be hyperactive (also weakened or disappeared), and most of them are weakened or disappeared in the middle and late stages. Lumbar 3-4 disc herniation may result in weakened or disappeared knee reflexes; lumbar 5 1, disc herniation may occur with reduced or disappeared Achilles tendon reflex; simple lumbar 4-5 disc herniation, generally no change in reflection.

Lumbar disc herniation (bulging) exercise test. This test is mainly to determine the positional relationship between the protruding disc and the spinal nerve root.

The tip of the iliac protrusion is located before the nerve root: the greater the lumbar forward flexion in the standing position, the heavier the lumbar pain; the lateral flexion or forward flexion to the healthy side, the pain is severe;

Sacroiliac protrusions are located on the inner side of the nerve root: when standing forward and bending to the healthy side, the pain increases; when the movement is reversed, the pain is reduced or disappeared.

(3) The protrusion is located outside the nerve root: when standing forward and bending to the healthy side, the pain is reduced or disappeared; the movement in the opposite direction increases the pain.

Diagnosis of lumbar disc herniation with disc herniation

The diagnosis of lumbar disc herniation is based on the following

Young adults have multiple lumbar disc herniations and often have a history of lumbar trauma.

Lumbar disc herniation is associated with lumbar buttock and leg pain. There are often clear tender points near the lumbar spinous process, which can induce exacerbation of radiation pain in the lower limbs. Pain in the waist, hips, and legs is good and bad, and repeated attacks are its characteristics.

Scoliosis of the lumbar spine, often plate-shaped, restricted waist movement, can not bend over.

Lumbar intervertebral disc herniation Compressed nerves in the compressed nerve distribution area, such as those with lumbar disc 4, 5 disc herniation, compression of the lumbar 5 nerve root, can cause lateral calf pain, foot back allergy or feeling dull.

The diaphragmatic muscle weakens, the muscle muscles dominated by the compressed nerves decrease, and muscle atrophy occurs as the pathology of lumbar disc herniation prolongs.

Knee and Achilles tendon reflexes weakened or disappeared.

The lumbar disc herniation test was positive for the straight leg elevation test, and the cantilever straight leg elevation was positive for radiation pain in the lower limbs.

XX-ray examination of lumbar disc herniation: Lumbar scoliosis can be seen in the lumbar spine, and the corresponding intervertebral space is narrowed, the sides are not equal, and osteophytes are formed.

Lumbar disc herniation can be performed with spinal radiography, CT, and magnetic resonance imaging, if necessary, to help understand the location and extent of disc herniation, and to make a clear diagnosis.

The causes and treatment principles of lumbar disc herniation

Lumbar disc herniation (bulging) is a common clinical disease in orthopedics. The main cause is that the disc tissue is based on internal factors such as degeneration and aging, and then encounters external factors such as sprains, strains, and cold, which rupture and relax the fibrous ring Protruding from the spinal canal or nerve root canal, stimulating or compressing the nerve, causing inflammation, degeneration and dysfunction of the nerve tissue, which causes a series of symptoms. Some patients have no obvious cause, and only develop in daily life such as cough, sneeze, defecation or sweeping the floor.

The key to the treatment of lumbar disc herniation (bulging) is to relieve nerve stimulation or compression, eliminate neural inflammation, and promote nerve repair of lumbar and vertebral function recovery. Treatment methods include surgical, non-surgical and interventional therapies. Which method is best should be different from person to person and disease to disease, and cannot be used to treat all patients with one therapy. The treatment process adopts an individualized scheme of treating the person and the disease, avoiding blindness and treatment setbacks.

Intervertebral disc herniation

Patients with lumbar disc herniation are mainly low back pain and sciatica. Before the onset of lumbar disc herniation, there is often a history of waist sprains, a history of waist strain or a history of colds.

This back and leg pain is aggravated by activities such as walking, standing, sitting, etc., and can be temporarily relieved after bed rest. Radiation pain that distributes along the sciatic nerve on one or both sides of the lower limbs extends from the buttocks to the back or outside of the thighs, and from the back of the lower legs to the back of the feet or soles of the feet. Individual patients may start with the lower leg or lateral malleolus. Half of the patients may have pain in the lower extremities due to coughing, sneezing or abdominal force. For patients with high lumbar disc herniation, the symptoms are mostly manifested in pain in the lower abdominal groin or anterior medial thigh. Patients with large disc herniation may develop abnormal urination or numbness in the saddle area of incontinence, and severe cases may have foot drop. Some patients with lumbar disc herniation showed coldness in their lower limbs due to the stimulation of their lumbar sympathetic nerves, and some also developed unilateral or bilateral lower limb edema.

First, move the hips: Lie on your back, first with your right leg suddenly extended to the front of the foot, while the hips swing to the right. Do your left leg again. The movements should be coordinated and powerful, with the legs alternated twenty to thirty times.

Second, kick: Sit on your back, flex your hips and knees as much as possible, and keep your back tight (dorsiflexion). Then, after the heel is kicked out obliquely upwards (about forty-five degrees), the muscles of the upper and lower legs are tightened and lowered to restore. Do the legs alternately twenty to sixty times.

Three, chest lift: Prone, support the bed with both hands, starting from the head back, at the same time, gradually supporting the hands to raise the chest up, and finally lean back, the strength reached the waist. Rest in peace and repeat five to ten times.

4. Fish Leap: Lie on your back with your hands on your waist, lift your upper body and legs back at the same time, and make it bow-shaped. Be careful not to bend your knees. Try to stay in this position for a while, the longer the better.

5. Lower waist and back extension: Stand with your legs apart about shoulder width and your toes pointed inward. Bend forward elastically, with herniated lumbar disc, making your hand touch the ground. Then reset and stretch back backwards, and also stretch back to the maximum amount. Repeat five to ten times, increase the range of motion after the condition improves, pay attention to step by step,

Intervertebral disc herniation for patients with lumbar disc herniation

Lumbar disc herniation is a motor system disease that is a common and frequently-occurring disease in orthopedics. Many factors can easily cause lumbar disc herniation. If there is a lumbar disc herniation, if you do not pay attention in daily life, it may cause symptoms and worsen the condition. If the treatment method is not selected properly, it will not only have no effect, but may also make the condition worse. The following are precautions for patients with lumbar disc herniation.

Intervertebral disc herniation of lumbar spine

Health examinations for adolescents or staff members should be conducted regularly. In schools, attention should be paid to checking for congenital or idiopathic deformities of the spine, such as scoliosis or vertebral arch collapse. If this is the case, disc herniation is prone to occur in the future, causing low back pain. For those who have been engaged in violent waist exercises for a long time, they should pay attention to the occurrence of pedicle fractures, which are more mobilized and acrobats. If there are structural defects, strengthen the back protection and do not perform violent exercises to prevent Repeated injuries.

Prolapse of intervertebral disc Lumbar disc herniation Precautions in life and work

Labor exceeding the maximum load of the lumbar spine can promote and accelerate aging and degeneration, causing lumbar disc herniation. If a lumbar disc herniation has occurred, it may easily lead to aggravation of the condition! So we need to try to avoid it in our work.

Don't bend over for a long time

For example, some work requires long-term bending, such as woodworking, wood shaving, farmer hoeing, etc. In these jobs, the pressure on the lumbar disc is more than doubled when standing. For example, when bending over to lift water from a well, the waist pressure can increase by 5 times! Therefore, the incidence of low back pain for long-term bending is high, and the incidence of disc herniation is also high. Long-term bending has a lot of pressure on the lumbar disc, which is not conducive to the rehabilitation of the lumbar disc.

Don't sit for a long time

Has long been engaged in sitting work, such as long-term desk workers, drivers, factory assembly line workers, etc., the incidence of low back pain is high. Sitting for a long time, the lumbar spine is in a backward bending state, the lumbar muscle ligaments are in a tense state, and the pressure on the lumbar disc is increased by 10 times! Long-term tension of the lumbar muscles and lumbar ligaments will cause chronic strain, which will reduce the stability and protection of the waist. At the same time, the overload of the lumbar intervertebral disc after prolonged sitting causes degeneration of the lumbar intervertebral disc, which is easily caused by external forces. The disc annulus ruptures and the nucleus pulposus compresses the nerve to delay healing. Therefore, it is very meaningful to stick to the gymnastics or change the position during working hours. We can stand and walk around every 20 ~ 30 minutes to develop good habits.

Don't use explosive power

The lumbar intervertebral disc tissue is located between the two lumbar vertebrae and bears the pressure and movement of the lumbar vertebrae. If suddenly overloaded with explosive force, it is easy to damage the disc. Therefore, we should move our waist slowly before exerting force. For example, when lifting heavy objects, first prepare for posture, do not apply sudden force to promote fracture healing. Especially when there is a lumbar disc herniation, the explosive force easily tears the originally stable lumbar intervertebral disc fibrous ring wound and aggravates the condition.

Do not exercise vigorously to avoid trauma

Trauma is also one of the main causes of lumbar disc herniation. Those with lumbar disc herniation are prohibited from any ball and unilateral exercise. Vigorous exercise also tears the ruptured fibrous ring wound of the lumbar disc herniation, exacerbating the protrusion. Especially in the acute phase of lumbar disc herniation, nerves appear edema and aseptic inflammation due to the compression stimulation of the nucleus pulposus. Vigorous exercise will exacerbate the frictional stimulation of nerves by the protrusions, which is not conducive to the regression of neuroedema and inflammation. Therefore, in patients with lumbar disc herniation, strenuous exercise is prohibited.

Don't sleep in a soft bed

Our normal spine has an S -shaped physiological curvature. Poor posture when sleeping, too high pillows, and too soft mattresses are not conducive to the physiological curvature of the spine, making the lumbar muscles tense, stiff, and poor blood circulation. , Is not conducive to the rehabilitation of lumbar disc herniation. Therefore, when we are going to sleep, the height of the pillow and the softness of the mattress should be moderate. The hardness of the mattress should not be deformed when people sleep on it, which is comfortable.

Don't be greedy

Lumbar disc herniation compresses nerves, which will cause normal nerve edema and inflammation, lower back muscles are tense, blood circulation throughout the waist is reduced, and the sensitivity of nerves to external stimuli is strengthened. The stimulation of cold air is not conducive to blood circulation in the waist, stimulating nerves and aggravating the symptoms of lumbar disc herniation, making the pain worse. Therefore, our waist keeps the waist cold and warm, and lumbar disc herniation, and we can apply heat to the waist to promote blood circulation and help relieve pain symptoms.

Don't eat irritating food

As the lumbar disc herniation compresses the nerves, it makes the nerves more sensitive to external stimuli. It is equally sensitive to coldness in food, tobacco and alcohol and other stimuli. It is not good for relieving pain caused by lumbar disc herniation. It should be avoided as much as possible.

Don't bend over to pick and lift

The lumbar intervertebral disc is between the upper and lower vertebral bodies, and it is in the front wide and narrow state. Suddenly bending down and picking things is not conducive to lumbar disc reentry. Lifting heavy objects often forces one side of the body and is not conducive to lumbar intervertebral discs, so to avoid, you should squat down when picking things up.

10 Intervertebral disc prolapse : 10 measures to prevent lumbar disc herniation

The life of modern people is not only a long life, but also a quality of life. A healthy back can not only make you move freely and be as light as a bird, but also make your cardiopulmonary function not degenerate due to sufficient exercise. In addition, when you really have a sore back, don't neglect to find a professional early to help you solve the problem, so that you are more healthy and energetic. A healthy spine can not only make you look more upright, but also relieve you from the pain of back pain. Here are ten ways to help you keep yourself healthy and away from illness.

First, when sitting:

White-collar workers spend most of their time sitting on chairs, so the sitting position is very important. When sitting, the back must be supported by the back of the chair. It is best that the back of the chair has a slightly protruding arc to support the back. In addition, the height of the knees can be slightly higher than the position of the hips, which can also reduce the pressure on the spine. Do not maintain a posture for more than an hour. You should move your body slightly, which will also help your back health.

When standing:

When we stand, the spine bears all of our body weight, so the standing posture is very important, and the normal spine has a certain curvature. Maintaining and maintaining a normal curvature can reduce the pressure on the spine, so it can reduce back pain. When you need to stand for a long time, you can alternately place one foot on a footrest with a height of about to cm. This can reduce the pressure on the back.

3. When picking up height items:

When picking up objects that are placed high, remember to stand on a footrest to reduce the possibility of spinal injuries.

4. When moving things:

Please remember to push as much as possible and use less pull. Use your arms and feet to start pushing when you are ready to push.

5. When lifting heavy objects:

When lifting heavy objects, use one foot in a half-kneeling position, and keep your body as close as possible to the object to be lifted, keeping the back straight, and remember to use the strength of your feet as much as possible to reduce back pressure.

6. When carrying goods:

When carrying items to promote fracture healing, it is easier to divide two small bags than one large bag, and try to keep the items close to the body to reduce the stress on the spine.

7. While sleeping:

When lying down, the spine suffers the least stress, so a moderate rest can also help reduce back pain. Placing a pillow under your knees when lying down or a pillow between your feet when lying down will help reduce spinal pressure.

Eight, weight control:

Remember that your spine bears your entire body weight. A good way to reduce your spinal stress is to maintain your standard weight. Imagine yourself carrying a 50kg sandbag and a 100kg sandbag, and then think about how many kilograms you want your spine to carry Sandbags? Ideal conditions Try not to exceed your standard weight by more than five kilograms to make you healthier.

Nine, quit smoking:

According to statistics, people who smoke have two to three times more back pain than non-smokers, because the nicotine in cigarettes can cause microvascular contraction and reduce nutrients in the spinal spine. The function of the spinal intervertebral plates gradually deteriorates and causes soreness. situation.

10. Minor back pain:

When there is a slight back pain, it is a warning signal, which must be taken seriously, please ask a professional doctor to deal with it to prevent the problem from becoming larger.