Lumbar disc herniation

Lumbar disc herniation is a common cause of low back pain. Based on the degeneration of the lumbar intervertebral disc, the injury of the waist can easily cause the nucleus pulposus and the damaged fibrous ring tissue to protrude backward, compressing the nerve root and causing a series of clinical manifestations. But there are many causes of sciatica, and sometimes the diagnosis is difficult. Clinically, lumbar tuberculosis or other diseases were misdiagnosed as disc herniation and performed surgery; others were diagnosed as disc herniation preoperatively, but nothing was found during the operation; although some cases can be explained by the self-retraction of the nucleus pulposus under anesthesia. However, it also explains the complexity of diagnosis; in addition, spinal canal, crypt, and root canal stenosis make diagnosis more difficult, and other diseases such as tumors and deformities must be excluded. Therefore, detailed examination and analysis must be performed before surgery, plus various auxiliary examinations, such as myelography, lumbar anterior epidural, and discography, which are of certain value for diagnosis and localization. The clinical application of ct scan, ctm, mri in modern times has greatly improved the accuracy of diagnosis. However, all of these tests can still produce false positives or false negatives, so they must not rely on instrumental examinations and ignore clinical examinations, let alone be used as a routine application. This disease can be treated non-surgically in the early stage, and only some patients need surgery. The purpose of the operation is to remove the protruding nucleus pulposus and the free fibrous ring tissue to relieve the compression of the nerve root. This operation is not a major operation, but requires meticulousness and skill, and the operation results are satisfactory. For those cases whose diagnosis has not been confirmed, non-surgical treatment should be performed first, and repeated inspections should be performed at the same time to further confirm the diagnosis. Exploratory investigation should not be taken as a means of confirmation. The satisfactory results of lumbar disc herniation can reach 78% ~ 92%. Poor results have been reported in 4.6% to 8%, and most of these patients require reoperation. The reasons are mostly due to: ① incorrect diagnosis; ② incorrect positioning; the disc herniation has not been removed; ③ improper selection of indications; ④ unskilled technology or rough operation caused complications such as bleeding, nerve root adhesion or injury; ⑤ incomplete surgery; ⑥ Postoperative infection; sacral nerve root compression time is too long. Therefore, affirmative diagnosis, strict indications, timely surgery, meticulous operation and prevention of complications are the fundamental measures to improve the efficacy of surgery.

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