What is Lower Back Pain?

A patient's dural sac is generally uncompressed and is also called an intravertebral disc disorder. It was first proposed by Crock in 1970. As an important cause of low back and leg pain, scholars pay more and more attention to it.

Discogenic low back pain

Discogenic low back pain is a disease that is gradually discovered and recognized during the diagnosis and treatment of low back and leg pain. Is due to abnormal internal structure and metabolic function of one or more discs, such as disc degeneration (including nucleus pulposus, fibrous ring rupture, and cartilage endplate damage) or release of certain factors (inflammatory mediators), which stimulates intracranial disc headache receptors Caused by low back pain.

Overview of discogenic low back pain

Pathogenesis of discogenic low back pain

With the widespread application of immunohistochemical techniques, people's understanding of the pathogenesis of discogenic low back pain has further deepened. There is increasing evidence that the underlying pathogenesis is an inflammatory response. Inflammation and abnormal mechanical movement cause nerve endings in front of the fibrous ring to irritate and cause pain, which can even induce pain during palpation of the abdomen. However, different types of intervertebral disc diseases are not the same in terms of nerve conduction pathways and inflammatory transmitter production mechanisms, and these differences are of great significance for the choice of treatment methods and prognosis. Sinusvertebral nerve (SVN) is considered as its afferent pathway.

Clinical manifestations of discogenic low back pain

1. Age and medical history The age of onset is mostly around 40 years old, with or without history of trauma.

2. Symptoms and pain are often sore pain, mainly located at L4 ~ 5, L5 ~ S1 interspinous process, posterior condyle, posterior gluteal, groin, prefemoral, posterior femoral, greater trochanter and so on; after exercise, especially the spinal vertical stress plus Symptoms worsen after the age, and you cannot sit and stand for a long time; sitting symptoms are more serious than standing. Coughing and sneezing can aggravate the pain, recurrence, and last a long time (up to several months). Crock believes that irritating chemicals in the nucleus pulposus can flow around the nerve roots through the fissure of the annulus fibrosis to produce root radiant pain but without nerve damage such as numbness and weakness.

3. There are few objective signs on examination. No significant back tenderness, with or without lumbar spasm. But extension, lateral flexion, and rotation are all limited. The femoral nerve traction test is often negative, and low back pain or back pain is greater than leg pain during the straight leg elevation test. There are generally no signs of nerve damage. Abdominal palpation can sometimes induce low back pain.

Diagnostic criteria for discogenic low back pain

At present, there is no gold standard for the diagnosis of discogenic low back pain. It is generally believed that the following conditions must be met:

(1) With or without a history of trauma, low back pain recurrent, lasting longer than 6 months.

(2) Have typical symptoms and signs.

(3) CT positive discography or MRI showed typical single-segment signal reduction, and a high-signal zone appeared at the back of the fibrous ring.

Intervertebral discogenic low back pain treatment

(I) Daily family conservative treatment

Panogenic low back pain, with mild symptoms, does not require special treatment. First, pay attention to bed rest to prevent the lumbar spine from being oppressed by external forces. Second, use other methods to actively exercise the lumbar muscle strength, increase the strength of the anterior ligament, posterior ligament, and lateral ligament of the lumbar spine, and avoid the compression of the intervertebral disc to break through the human normal ligaments and protect the muscles. . Strengthening the waist muscles can prevent and delay the occurrence and development of lumbar spondylosis and treat early lumbar disc herniation. According to surveys, in the population with developed lumbar muscle ligaments and high strength, the chance of lumbar disc herniation to continue to develop has decreased by 80%. Therefore, the strong training of the ligaments around the waist and muscles is of great significance for the treatment and recovery of herniated discs. In this regard, it is recommended that patients with lumbar disc herniation pay more attention to some medical devices commonly used in China during daily home treatment, such as lumbar pain treatment belts, etc., which are common methods of daily home.

For patients with less severe pain and shorter onset of disease, conservative treatment can be adopted. Including bed rest, traction, massage, medication, waist circumference, physiotherapy, S2 nerve root perioperative sympathetic block. Specifically, a lumbar pain treatment belt can be used, which can achieve the comprehensive effect of fixed traction massage magnetic therapy, and can be worn with you when exercising and working.

(Two) hormone treatment

For patients who can not be relieved by long-term conservative treatment, patients can try intervertebral hormone therapy before surgery, and they must master the dosage and timing of hormones. However, there have been no reports of long-term effective treatment of intervertebral disc hormones.

(3) Representative methods include intervertebral disc thermotherapy and nucleoplasty.

Percutaneous puncture fibrous ring electrocoagulation (IDET) is an emerging invasive treatment with less damage in recent years. The active tissue of IDET is the fibrous ring, which heats the diseased fibrous ring through the heat-generating guide wire, shrinks the collagen fibers, burns the granulation tissue, and solidifies and invades the nerve endings, thereby stabilizing the fibrous ring and reducing the patient's pain; the characteristics of IDET It is temperature controllable and short-distance heating, which has less damage to surrounding normal tissues. Saal JA et al. Reported this approach at the 13th North American Spine Symposium and proposed an effective temperature regulation range for in vivo therapy. They found that IDET's relief of low back pain was comparable to or better than vertebral fusion, and functional recovery was better than vertebral fusion. And for the first time, IDET can completely relieve discogenic pain.

Nucleus plasty is a technology that has emerged later. It uses radio frequency energy to remove a small amount of nucleus pulposus and form holes in the nucleus pulposus, which ultimately reduces the pressure in the disc. Its working tissue is the nucleus pulposus, which has the following advantages compared with IDET: The working temperature is lower and the thermal damage to surrounding structures is small. The ablation tip is limited to the nucleus pulposus, which has better safety. The operation technique is easier to master and the operation time is shorter.

(D) surgical treatment

1. Surgical indications The treatment of discogenic low back pain has undergone decades of development, and there is no consensus on the surgical indications and methods. It is generally considered that surgery is considered in the following cases: recurrent symptoms occur for more than 1 year; conservative treatment is ineffective;

Positive discography.

2. Simple discectomy has lower relief rate and lower recurrence rate for low back pain. The important reason is that the painful substances in the intervertebral disc cannot be completely removed. The residual inflammatory mediators can still be used in the case of microvertebral instability or instability. Causes stimulation of nerve endings, so most scholars do not support the above method for the treatment of discogenic low back pain.

3 , posterolateral fusion Because posterior lateral fusion of intervertebral body micro-motion is enough to stimulate nerve endings to produce pain. Therefore, many scholars believe that the posterolateral fusion method should be abandoned, and the intervertebral fusion should be changed.

4. Intervertebral fusion Intervertebral fusion eliminates intervertebral micromovement as much as possible. In theory, the clinical satisfaction rate should be positively correlated with the fusion rate. The reason for the controversy is the lack of uniform standards for the evaluation of the two. For example, the fusion success rate is difficult to determine based on image diagnosis alone, and the clinical satisfaction rate is also related to smoking and psychological quality.

5. The efficacy of intervertebral discectomy and intervertebral Cage fusion is more certain. It can remove painful intervertebral discs and inflammatory substances, and also restore the stability of the spine. As long as the diseased disc is accurately positioned before surgery, it is usually clinical The effect will be satisfactory. However, after all, fusion is at the expense of the physiological structure and function of the intervertebral disc; after traditional intervertebral or laminar bone fusion, the functional compensation of the adjacent spinal functional units increases, resulting in increased stress in the area. Various pathological conditions such as proliferative degenerative arthritis of the articular process joints, spinal canal stenosis, and intervertebral disc degeneration occurred in adjacent segments of the surgery. In addition, large surgical trauma and expensive treatment are also disadvantages of fusion surgery.

6. Artificial disc replacement and nucleus pulposus replacement

(V) Minimally invasive treatment-radiofrequency thermocoagulation target therapy

Radiofrequency thermocoagulation target location is accurately positioned under a C-ray machine, constantly monitored under digital subtraction, and the precise guidance of the navigation system directly degenerates and solidifies the nucleus pulposus of the protruding part; shrinks to reduce volume and relieve compression. Does not damage normal nucleus pulposus, repairs the rupture of the fibrous ring, inactivates the supersensitive nerve endings of new lesions in the disc, directly blocks the release of glycoproteins and proteins in the nucleus pulposus, and warming It plays a good role in treating the damaged fibrous rings, edema nerve roots, and inflammatory reactions in the spinal canal. After treatment, the symptoms disappear immediately or alleviate. This method removes wherever there is disease, and does not hurt the place where there is no disease. The dedicated RF electrode for the nervous system is only 0.7mm. Like an acupuncture needle, the entire treatment does not require anesthetics, analgesics, antibiotics, and hormones. It is a physical change process without any side effects on the human body, making the treatment greener and more human. Into. These security measures are not available in any minimally invasive equipment and methods. The safety and treatment issues that doctors and patients are most concerned about are brought to the extreme, so that doctors can perform spine surgery to cure disc herniation as easily and naturally as walking and nagging. At the same time, the history of the treatment of intervertebral discs was changed, and the treatment method with the main purpose of accelerating regression was changed to the treatment method with the main purpose of repair. The treatment of disc herniation, cervical spondylosis, and cervical spondylosis of the spinal cord has pushed to the top of the medical community. There are many paraplegia patients who have not been cured by open surgery for more than six months. After radiofrequency thermocoagulation target treatment, patients return to work and become the biggest miracle and highlight of spine surgery in the 21st century. The most minimally invasive, the safest, the least painful, the fastest and the lowest risk treatment.

Intervertebral disc-derived low back pain safety

First, the therapeutic electrode of the high-efficiency safety neuron-specific radio frequency instrument is only 0.7mm, like an acupuncture needle. The entire treatment does not use anesthetics, analgesics, antibiotics, and hormones. It is a physical change process without any side effects on the human body. The nucleus pulposus is directly removed without damaging any normal tissue, making the treatment greener and more humane.

Second, the precise positioning of radiofrequency thermocoagulation target treatment is accurate positioning in the C-arm X-ray machine, digital subtraction is constantly detected, the precise guidance of the navigation system directly acts on the nucleus pulposus, the data is accurate to less than 1mm, the angle error Less than 1 degree makes the treatment more accurate and effective.

Third, the identification of the nervous system, the unique identification and stimulation function of the nervous system unique radio frequency instrument, can measure the nerve within 1cm of the treatment range, and accurate to distinguish the motor nerve or sensory nerve, that is to say during treatment you It is impossible to damage a patient's nerves. Even if you are not a doctor, nothing can happen.

Fourth, precise organization This equipment's unique impedance display function can accurately distinguish the nucleus pulposus fibrous ring, calcification points, bone and blood vessels, and accurately display with tones and numbers, making the treatment more accurate and safe.

Fifth, temperature controllable RF instrument can adjust the temperature arbitrarily, the error is below 2 , to ensure the safety during treatment, no infection and no thermal damage after treatment.

6. Accurate calculation Precisely calculate the volume of the lesion to be removed before treatment, and make a plan, that is, go as much as the nucleus pulposus of the lesion, making the treatment more efficient.

These six safety measures are not available in any minimally invasive equipment and methods. At present, the radiofrequency thermocoagulation target technology is mainly used for the treatment of repair, and gradually replaces the previous treatment of accelerating the disc replacement. The history of spinal minimally invasive treatment has epoch-making significance.