Lumbar disc herniation conservative treatment or surgery?
Article / Zhang Hua, reporter of jinyang.com, Li Chaojin, correspondent,
The vast majority of severe lumbar disc herniation can be relieved or cured by non-surgical treatment.
Many people suffering from the pain of lumbar disc herniation often face the dilemma of conservative treatment or surgical treatment in the process of seeking medical treatment. Lumbar disc herniation, when is suitable for conservative treatment? When is suitable for surgical treatment?
Pursuit of conservative treatment, hope to let go
Fan Dehui, a spine expert in the rehabilitation Acupuncture Department of the second Guangdong Provincial Hospital of traditional Chinese medicine, said that patients with lumbar disc herniation who were recommended for surgical treatment in other hospitals were often encountered in outpatient and ward, and they turned to conservative treatment for fear of surgical risk. Also often encountered after the operation of lumbar protrusion, left behind a variety of postoperative low back pain, lumbar activity adverse sequelae, need postoperative rehabilitation treatment of patients.
Picture: suffering from lumbar disc herniation, Mr. Chen has low back pain and walking difficulties. He can only sit in a wheelchair,
Mr. Chen is one of them. Fan Dehui said that Mr. Chen, 48 years old, suffered from repeated low back pain for more than a year. He has been doing massage, physiotherapy and other rehabilitation treatment in the community outpatient clinic, sticking pain relief ointment. In the past month, the pain has not decreased, but has become more and more serious, affecting the lower limb movement function, so he can only sit in a wheelchair. After seeing a doctor in many large hospitals in Guangzhou, he was diagnosed with severe lumbar disc herniation, and most doctors also recommended surgical treatment. However, because he heard that a colleague was paralyzed in bed after lumbar disc surgery, he was psychologically afraid of surgery and still wanted conservative treatment.
Fan Dehui said that when he first met Mr. Chen, he was mentally tired, with painful expression, low back pain, radiation pain in his right lower limb, numbness and coldness. His waist movement was limited, and the pain was severe when he moved a little. After bed rest, his symptoms were slightly alleviated, but it was difficult to walk, so he could only sit in a wheelchair and urinate normally.
Physical examination showed that lumbar motion was obviously limited. MRI of lumbar spine showed: 1. Lumbar 5 / S1 disc herniation and prolapse (right posterior type), secondary corresponding spinal stenosis; 2. Lumbar 4 / 5 disc mild bulging; 3. Lumbar degeneration.
According to the patient’s symptoms, signs and imaging examination, fan Dehui assessed that Mr. Chen really reached the relative indication of surgical treatment, but he firmly disagreed with surgical treatment, hoping to give up and do conservative treatment first.
Traditional Chinese medicine characteristics, comprehensive treatment to improve low back pain
Considering the limited outpatient treatment, fan Dehui admitted Mr. Chen. At the time of admission, because of severe low back and leg pain and severe limitation of activities, he could only rest in bed and received intravenous drip of mannitol and dexamethasone to dehydrate and reduce inflammatory reaction. At the same time, combined with the treatment of integrated traditional Chinese and Western medicine, promoting blood circulation, dredging collaterals and relieving pain, and taking vitamin orally to nourish nerves.
Illustration: drawing of faraway intervertebral space with traction and shaking / interviewee provided wpap60302br
In addition, van der Fai also used the long’s chiropractic manipulation of shaking legs and kneading waist method to relax local muscles and relieve muscle tension; used lateral lying and pressing method to correct the dislocation of lumbar joints; used traction and shaking to punch Farah to open the intervertebral space, so that the protruding intervertebral disc was slightly displaced and recovered, and reduced the compression on peripheral nerve and spinal cord. At the same time, with acupuncture and moxibustion Shujing Tongluo pain, abdominal acupuncture Yiqi Peiyuan, strengthen healthy qi, local acupoint injection of traditional Chinese medicine to promote blood circulation Tongluo pain.
The picture shows that the herniated intervertebral disc is retracted into the
by setting the bone under overhanging traction
One week later, the patient had no obvious pain in the waist, so he could walk slowly out of the wheelchair, and then he was treated with special treatment, and the bone setting was carried out under the inverted traction, so as to use the human body’s own gravity to open the intervertebral space and recover the protruding intervertebral disc. At the same time, let them choose the swallow style exercise to enhance the strength of the low back muscle and the coordination of each muscle group, so as to play a compensatory role in protection, to achieve the effect of treatment and prevention.
Two weeks later, Mr. Chen’s symptoms improved significantly, he could walk slowly and his gait was OK. After discharge, Mr. Chen regularly outpatient treatment, adhere to low back muscle function and strength exercise. After 15 times of outpatient treatment, symptoms such as low back pain disappeared, walking was normal, and activities were not limited.
Experts believe that the following conditions can be treated conservatively:
1. Patients with first attack and short course of disease;
2. Although the course of disease is long, the symptoms and signs are mild
3. The special imaging examination showed that the intervertebral disc herniation was small or the nerve root had activity space
4. Because of systemic diseases or local skin diseases, surgery can not be performed;
5. Patients who do not agree with the operation or elderly patients.
Fan Dehui pointed out that the curative effect of conservative treatment depends on the patient’s compliance, the degree of trust in doctors, the patient’s psychological and physical quality, and the spiritual support of persisting in treatment and exercise. Surgical treatment and non-surgical treatment, each has its own indications, surgical treatment must follow the surgical indications, but the vast majority of severe lumbar disc herniation can be alleviated or cured by non-surgical treatment.
If surgery is absolutely necessary, do not expect conservative treatment.
According to Mr. Chen’s symptoms, signs and examination results, there are relative indications for surgery, but fan Dehui thinks that the patient is still young, and the course of disease is not long. MRI indicates nerve root compression and spinal canal stenosis, but there is still corresponding space for movement. Through bone setting manipulation, upside down traction combined with acupuncture and physiotherapy, the protruding intervertebral disc can be partially recovered, so as to reduce compression, relieve symptoms, and recover In order to achieve the purpose of rehabilitation and consolidation.
Fan Dehui said that patients with cauda equina syndrome, incontinence of urine and feces meeting the absolute indications of surgery must be treated as soon as possible, so as not to delay the disease. But a lot of patients like Mr. Chen, who have large prolapse of lumbar intervertebral disc and severe symptoms and are relatively suitable for surgery, can also achieve good results through conservative treatment.
The following are indications for surgical treatment of lumbar disc herniation: wpap60302br
1. Absolute indication wpap60302br
(1) Acute lumbar disc herniation, cauda equina syndrome; rectal and bladder sphincter dysfunction;
(2) Acute lumbar disc herniation, patients with pain, nerve root dysfunction, imaging evidence of large protrusion or spinal stenosis.
2. Relative indications wpap60302br
(1) Typical disc herniation, after regular systematic conservative treatment, did not improve for 4 to 6 months; or although it was alleviated, it often recurred and had severe pain, whose work and life were imaged.
(2) Lumbar disc herniation, long-term chronic pain and intermittent claudication, or recurrent attacks, imaging evidence of large protrusion, with primary or secondary spinal stenosis.
(4) The patient is middle-aged, has a long history and affects his work or life