"Ouch! My old waist!" "This often by the elderly while holding waist side issued a lament, now has become many middle-aged" catchphrase ", but also from the mouth of young adults in their 30s and 40s.
What's wrong with the modern waist? Many patients struggle with the question of whether to treat their waists conservatively or operate on them.
Let's start with a case.
Mr. Wang, an accountant, is known as an "iron abacus" by his colleagues because of his strong working ability and never making mistakes. His workload is large, working posture is also very single, often sitting in front of the computer for a whole day. As a result of long desk work, less than 40 years old his waist is not very good. His most noticeable sensation of late has been a sore back less than half an hour after sitting down to work, and a swelling in his left leg that didn't work with patches or massages.
After checking to the hospital, Mr. Wang is diagnosed as lumbar intervertebral disc herniation, the doctor suggests to do minimally invasive operation treatment, in order to get rid of the trouble of lumbago and leg pain. But Mr. Wang's friends hold the opposite view: "if you don't get it right, you'll be dead for the rest of your life. I heard someone had surgery on a lumbar spine and never stood up again!" This says, can frighten Mr. Wang, it is hard to choose to minimally invasive operation, but the waist leg pain that breaks out repeatedly is his heart disease.
1 "low back and leg pain" due to the lumbar spine disease
In the clinic, Mr. Wang is one of a number of patients with lumbering back problems. They ask all sorts of questions about whether my waist is going to be cured, whether I want to do it conservatively, what will be the after-effects of the surgery, etc. In conclusion, what patients want to know most is the choice between conservative treatment and surgical treatment.
This is probably what happens to everyone when they reach middle age. For example, whereas it used to be ok to drive for seven or eight hours on a road trip, now driving for more than an hour makes your legs ache. Before doing housework every day did not feel tired, now pull back to the waist straight not up. Serious people can't even sit down to attend a dinner party or play chess with old friends. They have to get up and move around several times. These signs, too, are beginning to show up in young people.
Everyone in life should have such experience: people around, many have complained of back pain, some of them 30 or 40 years old, let alone the elderly. Has waist disease become a public disease? This is not an exaggeration.
Lower back pain is associated with leg pain, which clinicians collectively refer to as "lower back and leg pain." According to statistics from the Chinese branch of the world pain physicians association, 1 out of every 10 patients who visit the hospital every year in China is a patient with low back and leg pain. The most common cause of these patients is known as herniated discs.
Low back and leg pain is a common symptom in clinical spectrum. In general, for patients with chronic lumbar disc herniation, lower back pain and leg pain tend to appear successively. Patients with early lumbago because of lumbar muscle injury, resulting in waist dare not bear weight. The weight bearing of the lumbar muscle can account for one third of the lumbar load, when the lumbar muscle strength is weakened or unable to bear normal weight, all the weight of the human body will fall on the disc, causing the disc to form herniation under the action of great pressure, thus pressing on the sciatic nerve and causing leg pain. Lumbago and leg pain can also occur at the same time, this is mostly due to the acute injury is more serious, such as lifting heavy objects beyond the waist muscles and disc bearing capacity, resulting in acute lumbar disc herniation and compression of the sciatic nerve.
Why are human lumbar discs vulnerable to injury
The lumbar intervertebral disc of the person is easy to injure, because be concerned with "person". This is not a tongue twister. Because human lumbar disc herniation is closely related to human upright walking.
When humans sit or stand, the lumbar spine bears almost all of the body's weight. In this respect, the quadruped, which is also a mammal, is fortunate in that it moves with its limbs to share the weight of its body and has little or no bearing at the waist.
Scientists found that the pressure on a human disc in the upright position is four times that in the supine position. The pressure when leaning forward in the sitting position is 7 to 8 times that in the supine position. Bending down to lift heavy objects is 10 times more stressful than in the supine position, which equates to a load of up to 220 kilograms on a lumbar disc.
Therefore, human physiology and lifestyle are indeed prone to lumbar disc injury. This is especially true for some professionals, such as accountants, drivers, teachers, it workers and heavy manual laborers, who are at higher risk of health problems in the lumbar spine due to their working posture and weight-bearing characteristics.
In fact, as a result of the long-term stress on the lumbar disc, humans begin to undergo degeneration in this area at the age of 20. A lumbar magnetic resonance imaging (mri) scan shows a herniated disc in the patient. At the same time, because of lumbar disc herniation, disc nucleus can overflow, contact with the immune mechanism of the body and immune response to produce pain, and secrete inflammatory substances leading to chemical stimulation and immune response, aggravating the symptoms of lumbar leg pain, this is called lumbar disc herniation.
What is the limit of surgical treatment
At present, there are three types of treatment methods for lumbar diseases: conservative treatment, minimally invasive surgery and open surgery. How do patients choose?
Generally speaking, the waist leg pain of inchoate or first attack is more because posture is bad, constant fatigue, exert oneself uncoordinated bring about. This kind of lumbar and leg pain is rarely related to lumbar disc herniation, mainly caused by lumbar back muscle tension or aseptic inflammation of the waist, which is commonly known as lumbar muscle strain. With timely conservative treatment, most people can recover their health.
Conservative treatments include topical plasters; The use of non-steroidal anti-inflammatory painkillers, such as fenbide, futalin, etc. Local physical therapy, such as ultra – laser irradiation, local massage. These methods can relieve muscle tension, promote local blood circulation, eliminate local inflammatory substances and play a therapeutic role.
Need what point reminds is, must carefully choose to massage. In clinical practice, the old person that companion has osteoporosis, because massage forces too much and bring about lumbar fracture, bone fracture is not uncommon. Above all, massage should choose regular medical establishment; Next, not all lumbago can undertake massage treatment, if lumbar spondylolisthesis, lumbar tuberculosis, lumbar tumour does not suit to undertake massage, when lumbago reason is not clear, do not want massage as far as possible, lest bring about illness aggravation, delay treatment.
For patients with chronic recurrent pain in the lower back and legs, first to the regular hospital imaging examination, such as ct, mri and other clear etiology. If a herniated disc is diagnosed, conservative treatment is often ineffective and surgery is ultimately needed to relieve or eliminate the pain.
In this case, the patient should not be afraid to seek medical advice. Modern medicine is changing, and surgery is not always what they think it is. Minimally invasive surgery, which has developed rapidly in recent years, is suitable for patients with early and intermediate diseases. The minimally invasive surgery does not require an operation. Under the guidance of the image, a special needle is used to puncture the disc herniation, and then the disc is melted and vaporized.
If long-term lumbago leg pain is not treated in time, the health harm to the person is great. When lumbar intervertebral disc disease aggravates, can produce intervertebral disc protrusion calcification, bony vertebra canal stricture, lumbar vertebra is medium above slippage to wait. At this point, the indications for minimally invasive surgery were exceeded, and only more invasive open surgery was performed. At present, the main methods of open lumbar spine surgery include artificial disc replacement, screw system implantation, etc., which have more complications than minimally invasive surgery.
Accordingly, the patient of long-term lumbar leg pain, should listen to the remedial proposal that professional doctor gives seriously. No matter conservative treatment, or minimally invasive surgery, open surgery has its clear surgical indications. For patients, it is indeed not necessary to do surgery at the beginning of early or acute stage lesions, but it is really not worth the cost to miss the conservative treatment period due to neglect of the disease, miss the optimal period of minimally invasive surgery due to fear of surgery, and finally have to do open surgery.
Lumbar muscle strain has nothing to do with bone injury
Psoas strain is also known as psoas fasciitis, a sterile inflammation characterized by soft tissue pain and tenderness in the lower back. Cold, strain, trauma and other factors related, and bone injury has nothing to do. The main characteristics of psoas fasciitis include local superficial pain after fatigue or cold, local soft tissue tenderness, palpable painful nodules or cord feeling, imaging examination usually no abnormal findings. Symptoms can be quickly relieved by injecting anti-inflammatory painkillers into the inflamed area of fascia.
The difference between prolapse and herniation of a lumbar disc
Lumbar intervertebral disc is bulging or protrusion, according to the main lumbar intervertebral disc protrusion in imaging diameter measurement to determine. General disc herniation in the lumbar spine line within 3 mm is called extrusion, protrusion 3 mm to 6 mm is called herniation, protrusion more than 6 mm is called prolapse or prolapse.
Clinical treatment of disc protrusion or herniation should not be based on the size of disc herniation as the main basis of treatment, but should be based on the patient's symptoms and combined with imaging findings to develop a treatment program. Prolapse or herniation of intervertebral disc in early and middle stage are indications for minimally invasive surgery.
Prevent lumbar disease from developing early
Lumbar muscle strain, disc protrusion, disc herniation 3 have distinction, have connection mutually again, belong to the same disease of different stage, with lumbago or lumbago leg pain is main clinical manifestation.
The onset of lumbar muscle strain is relatively urgent, mainly manifested by low back pain. There is aseptic inflammation in the lumbar muscles. Imaging examination shows no signs of disc degeneration. However, if the lumbar muscle strain persists for more than 3 months, most of them will develop disc protrusion or herniation, and produce intractable lumbago with lower limb pain. Imaging examination has the same conclusion.
Therefore, for acute onset, lumbago obvious patients can first oral analgesic drugs or local physical therapy, if lumbago can not continue to alleviate more than 1 month or lower limb pain symptoms, should be timely to the hospital.
(author: deputy chief physician of pain department of Beijing xuanwu hospital)
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