Lumbar disc herniation
Introduction
Introduction Lumbar disc herniation is one of the more common diseases, mainly because the lumbar intervertebral disc parts (nucleus pulposus, annulus fibrosus and cartilage board), especially the nucleus pulposus, have different degrees of degenerative changes, under the influence of external factors The annulus of the intervertebral disc ruptures, and the nucleus pulposus protrudes (or detaches) from the rupture in the posterior or spinal canal, causing stimulation or compression of the adjacent spinal nerve root, resulting in lumbar pain, numbness and pain in one lower limb or both lower limbs. Wait for a series of clinical symptoms.
Cause
Cause
1. Degenerative changes of the lumbar disc
The degeneration of the nucleus pulposus is mainly caused by the decrease of water content, and the small-scale pathological changes such as vertebral instability and loosening caused by dehydration. The degeneration of the annulus fibrosus is mainly manifested by the decrease of toughness.
2. Damage
Long-term repeated external forces cause minor damage and increase the degree of degeneration.
3. The weakness of the disc's own anatomical factors
The intervertebral disc gradually lacks blood circulation after adulthood and has poor repair ability. On the basis of the above factors, a certain predisposing factor that can cause a sudden increase in the pressure on the intervertebral disc can cause the less nucleus pulposus to pass through the fibrous ring that has become less tough, causing the nucleus pulposus to protrude.
4. Genetic factors
There is a report of familial morbidity in lumbar disc herniation, and the incidence of this type of color is low.
5. Congenital anomalies
Including lumbar vertebrae, lumbar vertebrae, hemivertebra deformity, facet joint deformity and axon asymmetry. The above factors can change the stress on the lower lumbar vertebrae, which constitutes an increase in intervertebral disc pressure and is prone to degeneration and damage.
Examine
an examination
Lumbar X-ray film
Simple X-ray film can not directly reflect the presence of disc herniation, but the degenerative changes such as narrowing of intervertebral space and vertebral edge hyperplasia are sometimes seen on X-ray films. It is an indirect suggestion. Some patients may have spinal deviation and spinal side. Convex. In addition, X-ray film can be found with or without bone disease, tumors and other bone diseases, with important differential diagnosis.
2. CT examination
It can clearly show the location, size, shape and nerve root and dural sac of the disc herniation. It can also show the laminar and ligamentum hypertrophy, small joint hypertrophy, spinal canal and lateral recess stenosis. In other cases, it has a great diagnostic value for this disease and has been widely used.
3. Magnetic resonance (MRI) examination
MRI has no radioactive damage and is important for the diagnosis of lumbar disc herniation. MRI can comprehensively observe whether the lumbar intervertebral disc is lesioned, and clearly show the morphology of intervertebral disc herniation and its relationship with the surrounding tissues such as dural sac and nerve root through different sagittal images and cross-sectional images of the intervertebral disc. In addition, it can be identified whether there are other space-occupying lesions in the spinal canal. However, the indication of whether the prominent intervertebral disc is calcified is not as good as CT examination.
4. Other
Electrophysiological examination (electromyography, nerve conduction velocity and evoked potential) can help determine the extent and extent of neurological damage and observe the therapeutic effect. Laboratory tests are mainly used to eliminate some diseases and play a differential diagnosis role.
Diagnosis
Differential diagnosis
Symptoms of lumbar disc herniation
(1) Lumbar posterior joint disorders The superior and inferior articular processes of adjacent vertebral bodies constitute the posterior lumbar vertebrae, which are synovial joints with nerve distribution. When the relationship between the superior and inferior articular processes of the posterior joint is abnormal, the acute phase may cause pain due to incarceration of the synovial membrane, and chronic cases may produce post-articular traumatic arthritis and low back pain. This kind of pain occurs mostly 1.5 cm beside the spinous process, and can have radiation pain to the ipsilateral hip or thigh, which is easy to be mixed with lumbar disc herniation. The radiation pain of the disease generally does not exceed the knee joint, and is not accompanied by signs of nerve root damage such as sensation, muscle weakness and loss of reflex. For cases with difficult identification, 5 ml of 2% procaine can be injected near the small facet joint of the lesion. If the symptoms disappear, the lumbar disc herniation can be ruled out.
(2) Lumbar spinal stenosis Intermittent claudication is the most prominent symptom. After a patient walks for a distance, the lower limbs are sore, numb, and weak. They must walk and rest to continue walking. Cycling can be asymptomatic. Patients with multiple complaints and few physical signs are also important features. A small number of patients have manifestations of root nerve damage. Severe central stenosis can lead to incontinence, special examinations such as spinal iodine angiography and CT scan can be further confirmed.
(3) Early lumbar tuberculosis of lumbar tuberculosis can stimulate adjacent nerve roots, causing low back pain and lower extremity radiation pain. Lumbar tuberculosis has a systemic reaction to tuberculosis, and the back pain is more dramatic. The destruction of the vertebral body or pedicle is seen on the X-ray film. CT scans have a unique effect on early localized tuberculosis lesions in vertebral bodies that X-ray films cannot.
(D) vertebral metastases pain increased, nighttime aggravation, the patient's physical weakness, can be found in the primary tumor. X-ray plain film can be seen in the vertebral body osteolytic destruction.
(5) Meningioma and cauda equina are chronic progressive diseases, without intermittent improvement or self-healing, often with incontinence. Cerebrospinal fluid protein increased, and the Quebec test showed obstruction. Myelography can confirm the diagnosis.
Symptoms: low back pain, lower extremity radiation pain, lower limb numbness, cold sensation and intermittent claudication, cauda equina symptoms.
