1. Non-surgical therapy
Most patients with lumbar disc herniation can be relieved or cured by non-surgical treatment. The principle of treatment is not to restore the degenerated and prominent intervertebral disc tissue to its original position, but to change the relative position between the intervertebral disc tissue and the compressed nerve root, so as to relieve the oppression on the nerve root, loosen the adhesion of the nerve root, eliminate the inflammation of the nerve root and relieve the symptoms. Non-surgical treatment is mainly suitable for: ① young, first attack or short course of disease; ② Symptoms are mild, and can be relieved by themselves after rest; ③ No obvious spinal stenosis was found by imaging examination.
(1) Absolute bed rest. During the first attack, you should stay in bed strictly, emphasizing that you can't get out of bed or sit up when urinating, which is better. Stay in bed for three weeks, you can get up under the protection of your waistline, and you don't have to bend over to get things for three months. This method is simple and effective, but it is difficult to adhere to. After remission, we should strengthen the exercise of back muscles to reduce the chance of recurrence.
(2) Pelvic traction can increase the width of intervertebral space, reduce the internal pressure of intervertebral disc and reduce the stimulation and oppression of nerve roots, which requires the guidance of professional doctors.
(3) Physical therapy, massage and massage can relieve muscle spasm and reduce the pressure in the intervertebral disc, but pay attention to the fact that strenuous massage can aggravate the condition and should be cautious.
(4) Supportive treatment can try to use glucosamine sulfate and chondroitin sulfate for supportive treatment. Glucosamine sulfate and chondroitin sulfate are clinically used to treat osteoarthritis in various parts of the body. These chondroprotective agents have certain anti-inflammatory and anti-cartilage decomposition effects. Basic research shows that glucosamine can inhibit the production of inflammatory factors by nucleus pulposus cells of spinal cord and promote the synthesis of glycosaminoglycan, a matrix component of intervertebral disc cartilage. Clinical studies have found that injecting glucosamine into intervertebral disc can significantly reduce low back pain caused by intervertebral disc degenerative diseases and improve spinal function. Some case reports suggest that oral glucosamine sulfate and chondroitin sulfate can reverse the degeneration of intervertebral disc to some extent.
(5) Corticosteroid epidural injection is a long-acting anti-inflammatory agent, which can reduce inflammation and adhesion around nerve roots. Generally, long-acting corticosteroids and 2% lidocaine are injected into epidural space once a week 1 time, three times for 1 course of treatment, and can be used again after 2 ~ 4 weeks/course of treatment.
(6) Chemolysis of medullary nucleus adopts collagenase or papain to inject into intervertebral disc or between dura mater and protruding nucleus pulposus, and selectively dissolves nucleus pulposus and annulus fibrosus without damaging nerve roots, so as to reduce the pressure in intervertebral disc or make protruding nucleus pulposus smaller and relieve symptoms. But this method has the risk of allergic reaction.
2. Percutaneous aspiration/laser vaporization of nucleus pulposus
Special instruments enter the intervertebral space under X-ray monitoring, and part of the nucleus pulposus is sucked or gasified by laser grinding, thus reducing the pressure in the intervertebral disc and alleviating the symptoms. It is suitable for patients with bulging or mild protrusion, but not for patients with lateral recess stenosis or obvious protrusion and patients with nucleus pulposus detachment from spinal canal.
3. Surgical therapy
(1) Surgical indications ① Patients with a history of more than three months but frequent recurrence and severe pain; (2) It is the first attack, but the pain is severe, especially the symptoms of lower limbs are obvious, and the patient is difficult to move and fall asleep, showing a forced posture; ③ Combined with cauda equina nerve compression; ④ Single nerve root paralysis, accompanied by muscle atrophy and decreased muscle strength; ⑤ Patients with spinal stenosis.
(2) Surgical methods include posterior lumbar incision, partial laminectomy and articular process resection, or discectomy through intervertebral disc space. After laminectomy, the central disc herniation is removed through epidural or epidural disc. Patients with lumbar instability and lumbar spinal stenosis need spinal fusion at the same time.
In recent years, minimally invasive surgical techniques such as microendoscopic discectomy, microendoscopic discectomy and percutaneous discectomy have reduced surgical injuries and achieved good results.