What Is a Percutaneous Endoscopic Discectomy?

Intervertebral disc The cartilage connection between the vertebral bodies of two adjacent vertebrae is called an intervertebral disc. It consists of a peripheral fiber ring and a central nucleus pulposus.

Intervertebral disc The cartilage connection between the vertebral bodies of two adjacent vertebrae is called an intervertebral disc. It consists of a peripheral fiber ring and a central nucleus pulposus.

Chinese Medicine Name

Intervertebral disc

Affiliated Department

Surgery-Orthopedics

Disease site

Lumbar, cervical

The main symptoms

Pain, numbness

Multiple groups

Middle-aged

Whether to enter health insurance

Yes

Intervertebral disc anatomy

1. There are 23 intervertebral discs in adults (there is no intervertebral disc between the 1st and 2nd cervical vertebrae), of which the intervertebral disc in the chest is the thinnest, about 2 mm; the intervertebral disc in the waist is the thickest, about 10 mm. Above 1/4 of the total length of the spine. The intervertebral disc is composed of a fibrous ring in the peripheral part and a nucleus pulposus in the central part. The fibrous ring is composed of multiple layers of fibrous cartilage rings, which firmly connect the vertebral bodies together. It has greater elasticity and toughness. In addition to bearing pressure, it can also prevent the nucleus pulposus from overflowing. The nucleus pulposus is a white jelly-like substance and is highly elastic. When the nucleus pulposus is affected by gravity, it expands all around, and squeezes the fiber annulus to extend and expand around.

2. When the spine moves, the disc produces a wedge-shaped deformation. If the spine is flexed forward, the first half of the intervertebral disc is flattened and thinned, while the second half is thickened, and the nucleus pulposus moves backwards; the opposite is true when the spine is extended. If the spine flexes to the right, the right half of the intervertebral disc becomes thinner and the left half thickens, and the nucleus pulposus moves to the left; when the spine flexes to the left, the opposite changes occur. Therefore, intervertebral discs have the effects of increasing the amplitude of spine movement, bearing pressure, buffering vibrations, and protecting the brain and spinal cord; at the same time, it is also the main reason for height changes.

3. The distribution of blood vessels in the intervertebral discs is richer than that of adults in early childhood, reaching the deep layer. As the age increases, the deep blood vessels gradually become smaller and the caliber becomes smaller. The nerves of the intervertebral disc are only distributed in the superficial layer of the fibrous annulus, but there is no nerve distribution in the deep layer and nucleus pulposus.

Intervertebral disc

For older people, height may become shorter due to atrophy of the disc. During spinal motion, the disc has the characteristics of wedge-shaped deformation and horizontal movement of the nucleus pulposus. Therefore, when the spine is rotated or flexed, the disc is squeezed and thinned on the same side, while the opposite side is subject to tension, tension and The role of torsional force. When this force exceeds the capacity of the intervertebral disc, the fiber ring is damaged and the nucleus pulposus overflows. The overflowing nucleus pulposus protrudes into the intervertebral foramina or spinal canal, compressing the spinal nerve root, and produces a series of symptoms of disc herniation. After people reach middle-aged and elderly, the discs undergo degenerative changes, weakening their elasticity and toughness. If the upper body flexes too hard, it can easily cause disc herniation.

Common Diseases and Treatment of Intervertebral Discs

1. Lumbar disc herniation is one of the most common causes of lumbar and leg pain clinically. There are many treatments for lumbar disc herniation, which are roughly divided into three categories: surgical treatment, conservative treatment and percutaneous treatment.

2. Conservative treatment is mostly individualized treatment, including: bed rest, local manipulation, hot compress, traction, physical therapy, lower back muscle exercise; mannitol dehydration in the acute phase; oral painkillers, non-steroidal anti-inflammatory drugs, neurotrophic drugs Wait. Percutaneous treatment is a treatment method between surgical treatment and conservative treatment. It mainly includes chemical nucleus pulposus, laser disc decompression (PLDD), percutaneous endoscopic laser discectomy (PELD), Intervertebral disc electrotherapy (IDET) and epidural hormone injection therapy. There are many researches on non-surgical treatment of lumbar disc herniation, and most of them are retrospective studies. There are controversies on the clinical effect of non-surgical treatment.

3. Minimally invasive treatment has the advantages of less trauma, good curative effect, less bedtime, fewer complications, less easy to damage the spinal cord and marrow stability, less pain for patients, and quick recovery. It has become a new trend in the treatment of lumbar disc herniation, but minimally invasive treatment requires the surgeon to have rich clinical experience and minimally invasive surgical skills, and in clinical practice to strictly select its indication according to the characteristics of various minimally invasive surgery to obtain satisfaction Efficacy. With the continuous improvement of the treatment of lumbar disc herniation, a single treatment method has its own advantages, indications, and so on. However, the scope of treatment is relatively small; the principle of non-invasive four-dimensional traction treatment is to correct spinal deformities by adjusting the physiological curvature of the spine through up and down angled traction, left and right rotation traction, longitudinal distraction and discoscopy. Relieve the symptoms of compression and stimulation of the disc herniation. The principle of the treatment of percutaneous puncture of lumbar intervertebral disc is to reduce the pressure of the nucleus pulposus by the vaporization, cutting, and coagulation of the nucleus pulposus tissue by laser to reduce the pressure of the intervertebral disc. To achieve the purpose of alleviating or eliminating clinical symptoms. However, four-dimensional traction can not reduce nucleus pulposus and disc pressure; percutaneous puncture of lumbar disc herniation cannot correct spinal joint disorders, adjust spinal physiological curvature, and correct spinal deformities. Both four-dimensional traction and minimally invasive laser vaporization have the advantages of convenient operation, less trauma, less bleeding, fewer complications, and less stability to the lumbar spine. For example, the combined treatment of lumbar disc herniation can be combined with each other to relieve the pain of patients and restore normal physiological curvature is a new direction of clinical medical research to treat lumbar disc herniation.

Causes of Intervertebral Discs

The basic factor is intervertebral disc degeneration, but certain inducing factors can cause increased intervertebral space pressure and cause nucleus pulposus. Such triggering factors are often related to the following factors:

Disc age factor

Lumbar disc herniation occurs at the age of 30-50 years. The average age of surgery was 40 years. Therefore, regression may be an important factor.

Disc height and gender

Some people think that too tall can also be prone to lumbar protrusion. The incidence of men is five times that of women.

Intervertebral discs increase abdominal pressure

Clinically, about one-third of patients have definite factors that increase abdominal pressure before onset, such as severe cough, sneezing, holding breath, and forced defecation. Increased abdominal pressure, disrupted the balance between the vertebral segment and the spinal canal.

Poor disc position

As people complete various tasks, they need to constantly change their positions to relieve waist stress. If it stays in a certain position for a long time, it can lead to local cumulative damage. Especially in the long-term poor posture is more likely to induce the disease.

Disc Occupational Factors

The incidence of heavy manual workers is the highest, and that of white-collar workers is the lowest. The driver of the car is prone to bumps and vibrations for a long time, and the pressure on the disc is large and repeated, and it is easy to induce disc herniation.

Cold and wet disc

Cold or humidity can cause small blood vessels to contract, muscle spasms, increase the pressure on the disc, and possibly cause degenerative disc rupture.

Intervertebral disc treatment

Intervertebral disc traction treatment

We all know that lumbar disc herniation is divided into three types: bulging, protruding and prolapsed according to the size of the protrusion. According to the severity of clinical symptoms, patients with lumbar disc herniation are divided into acute phase and remission phase. At the first onset, general hospitals recommend that patients first use traction treatment. The traction mainly draws the intervertebral space with mechanical force, which reduces The internal pressure of the intervertebral disc slightly reduces the compression of the nerves by the protrusions, which is theoretically correct, but the clinical treatment effect is indeed not ideal. This is mainly because the strength of traction varies from person to person, and it is difficult to hold; the other is that the choice of indication is difficult to distinguish accurately; and the other is the cooperation of patients. For patients with lumbar disc herniation, the internal disc pressure is very high at this time and can be cured by traction, but it is ideal to be absolutely bedridden during traction. If walking, riding, etc. immediately after traction will restore the high pressure in the intervertebral disc, causing traction to be ineffective. Traction is only suitable for patients with disc herniation. If the disc has caused protrusion and prolapse, traction is completely ineffective and may worsen the patient's symptoms. In the acute phase of lumbar disc herniation, traction is a contraindication. Because in the acute phase, due to the edema of the nerve roots and inflammation, it will cause tension and cramps in the lower back muscles. If traction at this time will strain the lumbar muscle fibers, causing back pain and aggravating clinical symptoms.

Intervertebral disc physiotherapy

Physical therapy, including electrotherapy, infrared irradiation, and thermal therapy, is basically the same as the therapeutic purpose of massage and acupuncture. It is mainly to relieve the clinical symptoms of patients, rather than radical cure. Because most patients with lumbar process accompany chronic lumbar muscle strain, piriformis muscle tension, muscle spasm in the nerves compressed by the lumbar disc herniation, causing lumbago and leg pain, general hospitals will use physical therapy, massage, acupuncture and other treatment methods. To relieve muscle tension and cramps. Therefore, patients who have undergone physiotherapy know that they will be more comfortable during physiotherapy, and will be the same as before if they are not.

Intervertebral Disc Food Therapy

(1) 25g kelp, 15g litchi, 15g cumin. Boil with water and drink once a day.

(2) 500g of raw leek (or root), warmed with pounding sauce, 500ml each time, 2 times a day.

(3) 300g mussels. Dry the ground powder, stir-fry with 150g of black sesame, mix well, and serve one spoon each morning and evening.

(4) 15g of sesame and 100g of rice. Wash the sesame seeds with water, stir-fry them slightly and grind them into a mud, then increase the rice to make porridge. One dose daily for breakfast.

(5) 15g black sesame seeds and 10g barley seeds. Milled once a day.

Intervertebral disc closure

There are two methods of closure treatment, one is intraspinal canal closure and the other is nerve root closure. As the name suggests, intravertebral canal closure is the direct injection of drugs into the spinal canal, and nerve root closure is the injection of drugs around the nerve root. The injected drugs are mainly adrenal corticosteroids and local anesthesia. Under the action of hormones, aseptic inflammation and edema of nerve roots can be reduced and eliminated; narcotic drugs stop pain, and anesthesia nerves reduce their sensitivity. We all know why lumbar process causes lumbar and leg pain, which is mainly due to edema and aseptic inflammation of nerve roots caused by compression of nerves in the lumbar disc nucleus pulposus, so the effect of closure is analgesia, and compression of protrusions cannot be resolved. After the effect, the symptoms of back and leg pain resumed immediately.

Disc Needle Knife Therapy

Needle knife therapy is divided into water needle knife and small needle knife.

Water acupuncture is an injectable acupuncture tool developed by combining the "knife needle" of Zhang Zhongjing's medical sacred temple in the Qing Dynasty with modern medical water acupuncture and softening the essence of other acupuncture therapies. Water acupuncture as a descendant of traditional Chinese medicine and acupuncture and modern medical water acupuncture, is a new type of injection microsurgery under non-direct view between acupuncture and open surgery, using soft tissue local anatomy , Three-dimensional anatomy, dynamic and static three-dimensional anatomy, biomechanics, bioinformatics, meridian theory, aseptic inflammation and dynamic and static equilibrium, and Chinese and Western pharmacology as its theoretical basis. It has broad prospects for the treatment of soft trauma diseases and spine-related diseases.

Small needle knife therapy is a new treatment method developed on the basis of acupuncture and closed therapy. In recent years, its treatment effect has been gradually "deified". The small needle knife is a surgical instrument called a needle knife, which performs extensive stripping and release on the pain points of patients with low back and leg pain, and then injects local anesthetic drugs and hormone drugs to play an anti-inflammatory and analgesic effect. The purpose of the small needle knife is to The expansion of the closed range creates conditions. Therefore, the small needle knife treatment is actually an improvement of a closed therapy, and its treatment effect is equivalent to closed.

Intervertebral disc surgery

Conventional open surgery

Conventional open surgery includes: total laminectomy, hemi-laminectomy, trans-abdominal disc surgery, and vertebral fusion. The purpose of surgery is to directly remove the diseased lumbar intervertebral disc nucleus pulposus and relieve nerve root compression to achieve the purpose of treatment. Due to the limitation of the special physiological position of the lumbar spine, the surgery destroys the normal physiological structure of the lumbar vertebra, resulting in large surgical damage, easy to cause postoperative instability of the lumbar spine, postoperative scar tissue adhesion, and accidental injury to the nerve root during the operation. So most patients are afraid of surgery. How to avoid the above adverse reactions caused by surgery? This has always been a big problem in the medical community

Minimally invasive discectomy

In order to avoid the major injuries of conventional open surgery and reduce the risk and complications of surgery, microsurgery and arthroscopy assisted lumbar disc surgery, although it reduces the damage to normal bones and joints during surgery, but Minimally invasive surgery is also surgery, and there are risks and complications. Another major problem is that after the surgical field becomes smaller, it is difficult to completely remove the diseased lumbar disc nucleus, increasing the risk of unsuccessful surgery.

Percutaneous aspiration

Most patients with lumbar disc herniation are prolapsed due to increased pressure in the disc. Percutaneous puncture and suction can significantly reduce the internal disc pressure and reduce the disc contents, thereby reducing or eliminating the symptoms of nerve compression by the protrusions. The advantage of this method is that the injury is small during the operation, but the disadvantage is that the operation is mainly decompression, which is effective for intervertebral disc bulging, and is prohibited in the types of prolapse, dissociation, and calcification of lumbar process, which makes the surgical surface too narrow.

Collagenase chemolysis

Human intervertebral disc nucleus pulposus is composed of water, fibrous tissue, and proteoglycan. The full name of collagenase: collagen lysozyme, which can dissolve nucleus proteoglycan. Therefore, the use of this therapy has been banned abroad; moreover, if collagenase dissolution therapy fails, extensive scar adhesion will be formed inside and outside the intervertebral disc, which will make subsequent treatment difficult. Our regular hospitals in China have basically disabled collagenase, but There are also some private hospitals or private individuals using this method to treat lumbar process.

Intervertebral disc ozone injection therapy

High-concentration ozone has astringent and gasifying effects. With this effect, very few hospitals use lumbar process for treatment. In theory, the injection of ozone can vaporize and condense the nucleus pulposus of the lumbar intervertebral disc, but what are the chemical reactions and complications of ozone entering the spinal canal? This needs further observation and research. From the feedback of patients, the success rate of this treatment method is not too high.

to sum up:

Principle of treatment method selection: Try to choose non-invasive conservative treatment methods, such as drug treatment. Minimally invasive interventions, including injuries, are listed after conservative treatment methods, and other treatments can be considered if conservative treatment is not effective.

Intervertebral disc herniation can be considered for simple disc bulging, not minimally invasive or conventional surgery;

Simple protrusion can be considered minimally invasive treatment, do not consider interventional treatment or conventional surgery;

Outstanding complexity (prominent in many places) should consider routine surgery, not minimally invasive and interventional;

With spinal canal stenosis and yellow ligament hypertrophy, routine surgery should be selected;

Intervertebral disc herniation with calcification should choose routine surgery;

The elderly and infirm should try not to consider the treatment of injuries, including surgery, minimally invasive, and intervention. They should be treated conservatively;

Swelling and mild protrusion are generally treated with conservative treatment or intervention; those with severe protrusion and prolapse should choose minimally invasive or surgical treatment.

In recent years, internationally, interventional methods have been used to treat disc herniation. Super oxygen plasma therapy and collagenase therapy have achieved good results, less pain, safety and no complications, fast recovery, and greatly reduced surgical costs. Such significant features have been warmly welcomed by the majority of patients. In particular, the combined application of superoxide plasma and collagenase for the treatment of herniated discs has been shown by the Second Affiliated Hospital of the Fourth Military Medical University to have an effective rate of over 96%.

Intervertebral disc: The adjacent two vertebrae are firmly connected by the intervertebral disc. The spine is the thinnest in the middle of the thoracic spine, and gradually thickens upwards and downwards, while the waist is the thickest, so the spine has the largest lumbar motion.

Intervertebral disc replacement therapy

The so-called alternative medical treatment refers to a therapy outside the traditional western medicine, and its efficacy can replace or supplement the role of western medicine. Compared with traditional therapies, the risks of surgery are often difficult to cure, and alternative therapies are more fundamental and safer.

Intervertebral disc treatment principles

First consider conservative treatment. Conservative treatment is ineffective and then consider surgical treatment.

Treatment of lumbar disc herniation There are three main types of treatment for lumbar disc herniation:

I. Non-surgical treatment includes

1. Bed rest 2. Drug therapy 3. Traction therapy 4. Physical therapy 5. Massage therapy 6. Acupuncture therapy 7. Closed therapy 8. Small needle knife therapy

Included in surgical treatment

1. Routine open surgery (including: semi-laminectomy, total laminectomy, trans-abdominal disc surgery) 2. Minimally invasive discectomy.

3. Percutaneous puncture and aspiration 4. Artificial lumbar disc replacement.

3. Interventional treatment includes :

1. Collagenase chemical dissolution therapy 2. Ozone injection therapy 3. Ultra-low temperature ablation treatment 4. Radiofrequency thermocoagulation target puncture technology 5. Semiconductor laser ablation

People affected

(1) In terms of age: herniated discs occur in young adults.

(2) From a gender perspective: Prolapse of intervertebral discs is more common in men, and the incidence of men is higher than that of women. Generally, the ratio of men to women is 7: 3.

(3) In terms of body type: Generally, people who are too obese or too thin are prone to cause disc herniation.

(4) Occupationally speaking: Industrial workers with higher labor intensity are more common, and the incidence of mental workers is not very low.

(5) In terms of posture, it is more common for staff members with poor working postures and sales workers who are often standing.

(6) In terms of living and working environment: often in cold or humid environments, to some extent, it becomes a condition that induces lumbar disc herniation.

(7) From women's different periods: prenatal and postnatal and menopause are dangerous periods for female disc herniation.

(8) People with congenital lumbar spinal dysplasia or deformity, and even people who are too nervous are prone to waist and leg pain and smoking, and cough may cause increased disc pressure and spinal canal pressure, making them prone to degenerative Change related

Intervertebral disc exercises

Intervertebral disc preparation posture

Separate your feet and shoulder width, your arms hang down naturally, your body is relaxed, your eyes are flat, you can breathe evenly, and you can sit and sit.

Intervertebral disc rubbing neck with both palms

Cross your fingers on the back of your neck and rub it back and forth 100 times.

Intervertebral disc

Turn your head to the left and then to the right. The amplitude should be large. It is better to consciously swell, 30 times.

Disc nodded back and forth

When the head is moved forward and backward, the neck is stretched and stretched as far as possible 30 times.

Intervertebral spiral shoulder and neck relaxation

With both hands, place the palms of the shoulders on both sides down, and rotate the arms 20-20 times from back to front, and then 20-30 times from front to back. Looking up at the moon: Turn your head to the left, and lean back as far as you can. After looking at the upper left for 5 seconds, turn it to the right and look at the upper right for 5 seconds.

Intervertebral disc

Raise your hands over your head, palms up, and look up the back of your hand for 5 seconds.

View of the intervertebral disc

With your hand back to your chest, with your right hand outside, Lao Gong acupoints overlap, press the middle of the imagination, and look at the front for 5 seconds.

Intervertebral disc prevention

Intervertebral disc

1. The bed should be moderately soft and hard to prevent the bed from being too hard or too soft so that the lumbar muscles can be fully rested. Avoid the wind and cold invasion of the waist and prevent the waist from being in a posture for a long time. .

2. Application of the waist: Use the waist correctly. When squeezing and lifting heavy objects, you should first squat. When using the waist for a long time, you should change the posture of the waist and do more waist activities to prevent gradual strain. When mild strain has occurred, symptomatic Chinese medicine can be taken to avoid further aggravation of the strain, and eventually cause degenerative changes in the lumbar spine.

3. Lumbar health exercise: Adhere to the lumbar health exercise, often carry out activities in all directions of the lumbar spine, so that the lumbar spine always maintains a physiological stress state, strengthen the exercise of the lumbar and abdominal muscles, and the strength of the lumbar and abdominal muscles can increase the stability of the lumbar spine And strengthen the protection of the waist to prevent degenerative changes in the lumbar spine.

Intervertebral disc cervical spine

1. When sleeping, the height of the pillow is equivalent to the width of the shoulder. It is suitable for softness and rigidity. Cover your quilt when sleeping to avoid coldness in the neck and shoulders.

2. While reading, studying or working, you should always change the posture of the neck. After a certain period of time, you should move the cervical spine to avoid neck muscle fatigue and normal cervical curvature changes.

Intervertebral disc thoracic spine

1. Avoid getting cold on the back, can do proper back activities, and can perform light massage or physical therapy appropriately.

2. Avoid re-injury of the thoracic spine caused by lifting and carrying heavy objects.

Failed back Surgery Syndrome

Lumbar Surgery Syndrome ("FBSS" for short) is a refractory disease, with postoperative intractable pain, cauda equina adhesions, and urination disorders caused by injuries being the most common. Western medicine's treatment of this disease mainly depends on "tramadol, meshikangding" painkillers or "analgesic pumps", etc., which is very traumatic to patients. Director Huo of Henan Traditional Chinese Medicine first proposed the traditional Chinese medicine "fascial shock" therapy, and developed a series of "stagnation and stagnation pain" series of prescriptions, which are soft and firm, loosening, promoting blood circulation, swelling, menstruation, and anti-fibrosis, which can quickly relieve patients. Pain, numbness, atrophy, and constipation, etc., make up for clinical shortcomings such as high risk, large trauma, and multiple sequelae of surgical treatment of western disc surgery, and further improve the cure rate of cervical and lumbar disc herniation.

Intervertebral disc daily exercise

Intervertebral disc exercise

However, with the increase of age, the structure of the lumbar intervertebral disc is aging, and its elasticity and anti-load capacity are also reduced. Once it is overworked or inadvertent, it will easily rupture the fibrous ring of the intervertebral disc and form disc herniation. Back pain. Frequent five-step exercises can help restore the elasticity of the disc and reduce the incidence of low back pain. The five-step exercises are as follows:

1. In a supine position, with your eyes looking up, your arms flat on the sides of your torso, your palms down, your legs straight, your feet close together, and your toes pointing up. Raise your legs, raise 15-30 degrees, then lower. Lift your legs slowly and let them go fast. Repeat 10-12 times.

2. Lying on the right side, with both eyes looking straight to the front right, with the right arm under the head and the left arm on the right side of the trunk. Raise the left leg by 15 degrees and perform flexion and extension exercises 10-12 times. Slowly bend your legs and stretch your legs fast.

3 Lying on the left side, with both eyes looking up at the left front, with the left arm under the head and the right arm on the left side of the trunk. Raise the right leg by 15 degrees and perform flexion and extension exercises 10-12 times. The requirements are the same as above.

4 Sit cross-legged, with your eyes looking straight ahead, your arms turned, and your palms pressed against your waist. The body flexes to the left and right sides 10-12 times each, the amplitude is small, the speed is slow, and the angle is not limited.

5. Sit with your legs straight, your eyes straight ahead, your arms straight forward, at a 90-degree angle to your torso, and rotate your body 10 to 12 times to the left and right.

Intervertebral disc precautions

Patients with disc herniation should not wear any heeled shoes. High heels are harmful to common sense, and mid-heeled shoes and wedge heels also have the same function. They both move the center of gravity forward and easily lead to increased spinal curvature. Compared with high heels, it is only a degree. The problem, and academics have long pointed out that the health of mid-heel shoes is pseudoscience. This unfavorable factor is easily overlooked. For patients with disc herniation, it is even worse, and patients who need rehabilitation should pay more attention.

At the same time, it should be noted that the rehabilitation exercise is different from the exercise in the usual sense. The usual exercise belongs to active body, games and sports. There are no contraindications, but the patients are different. Don't forget your physical condition, don't leave room to challenge your limits, don't do high-intensity strenuous exercise and over-exercise, avoid the sudden rise and forget about it, especially the competitive events that have physical contact with others try not to participate. Mountain climbing is not suitable for patients with disc herniation, especially for steep slopes and rock climbing. Abdominal pressure will increase significantly, and the waist is in flexion. The combination of the two forces can easily cause the nucleus pulposus to move backwards and cause recurrence.